37 research outputs found
Oscillating Flow in Channels with Sudden Change in Cross Section
In this paper, we have computationally examined oscillating flow (zero mean between) two parallel plates with a sudden change in cross section. The flow was assumed to be laminar incompressible with the inflow velocity uniform over the channel cross section but varying sinusoidally with time. The cases studied cover wide ranges of Remax (from 187.5 to 2000), Va (from 1 to 10.66), the expansion ratio (1:2 and 1:4) and Ar (2 and 4). Also, three different geometric cases were discussed: (a) asymmetric expansion/contraction; (b) symmetric expansion/contraction; and (c) symmetric blunt body. For these oscillating flow conditions, the fluid undergoes sudden expansion in one-half of the cycle and sudden contraction in the other. The instantaneous friction factor, for some ranges of Remax and Va, deviated substantially from the steady-state friction factor for the same flow parameters. A region has been identified (see Fig. 3) below which the flow is laminar quasi-steady. A videotape showing computer simulations of the oscillating flow demonstrates the usefulness of the current analyses in providing information on the transient hydraulic phenomena
Oscillating flow and heat transfer in a channel with sudden cross section change
We have computationally examined oscillating flow (zero mean) between two parallel plates with a sudden change in cross section. The flow was assumed to be laminar incompressible with the inflow velocity uniform over the channel cross section but varying sinusoidally with time. The cases studied cover wide ranges of Re(sub max) (from 187.5 to 2000), Va (from 1 to 10.66), the expansion ratio (1:2 and 1:4) and A(sub r) (2 and 4). Also, three different geometric cases were discussed: (1) asymmetric expansion/contraction; (2) symmetric expansion/contraction; and (3) symmetric blunt body. For these oscillating flow conditions, the fluid undergoes sudden expansion in one-half of the cycle and sudden contraction inthe other half. The instantaneous friction factor, for some ranges of Re(sub max) and Va, deviated substantially from the steady-state friction factor for the same flow parameters. A region has been identified below which the flow is laminar quasi-steady. A videotape showing computer simulations of the oscillating flow demonstrates the usefulness of the current analyses in providing information on the transient hydraulic phenomena
Oscillating Flow in Channels with Sudden Change in Cross Section
In this paper, we have computationally examined oscillating flow (zero mean between) two parallel plates with a sudden change in cross section. The flow was assumed to be laminar incompressible with the inflow velocity uniform over the channel cross section but varying sinusoidally with time. The cases studied cover wide ranges of Remax (from 187.5 to 2000), Va (from 1 to 10.66), the expansion ratio (1:2 and 1:4) and Ar (2 and 4). Also, three different geometric cases were discussed: (a) asymmetric expansion/contraction; (b) symmetric expansion/contraction; and (c) symmetric blunt body. For these oscillating flow conditions, the fluid undergoes sudden expansion in one-half of the cycle and sudden contraction in the other. The instantaneous friction factor, for some ranges of Remax and Va, deviated substantially from the steady-state friction factor for the same flow parameters. A region has been identified (see Fig. 3) below which the flow is laminar quasi-steady. A videotape showing computer simulations of the oscillating flow demonstrates the usefulness of the current analyses in providing information on the transient hydraulic phenomena
Heat transfer in oscillating flows with sudden change in cross section
Oscillating fluid flow (zero mean) with heat transfer, between two parallel plates with a sudden change in cross section, was examined computationally. The flow was assumed to be laminar and incompressible with inflow velocity uniform over the channel cross section but varying sinusoidally with time. Over 30 different cases were examined; these cases cover wide ranges of Re sub max (187.5 to 30000), Va (1 to 350), expansion ratio (1:2, 1:4, 1:8, and 1:12) and A sub r (0.68 to 4). Three different geometric cases were considered (asymmetric expansion and/or contraction, symmetric expansion/contraction, and symmetric blunt body). The heat transfer cases were based on constant wall temperature at higher (heating) or lower (cooling) value than the inflow fluid temperature. As a result of the oscillating flow, the fluid undergoes sudden expansion in one half of the cycle and sudden contraction in the other half. One heating case is examined in detail, and conclusions are drawn from all the cases (documented in detail elsewhere). Instantaneous friction factors and heat transfer coefficients, for some ranges of Re sub max and Va, deviated substantially from those predicted with steady state correlations
Protamine induced right ventricular dysfunction and systemic hypotension during transcatheter aortic valve replacement
Application of organic fertilisers on natural stand bamboos for sustainable management in Peninsular Malaysia
This paper highlights research on the influence of three organic fertilisers (chicken dung, palm oil mill effluent and peat materials specially made for fertilisers) on the number of new shoots, the diameter at breast height, the height of the culms and the number of culms. Especially the number of new shoots and the diameter at breast height are positively influenced, which is promising for commercial purposes
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 a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial
Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma.
Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We
aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.
Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries.
Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the
minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and
had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were
randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical
apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to
100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a
maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h
for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to
allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients
who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable.
This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.
Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid
(5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated
treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the
tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18).
Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and
placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein
thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of
5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).
Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our
results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a
randomised trial
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
Global economic burden of unmet surgical need for appendicitis
Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially