Centreline shock reflection phenomena for Supersonic Internal Flows in the non-Rankine-Hugoniot zone: Overexpanded Supersonic Microjets

The viscous and rarefaction effects on centreline shock reflection occurring in an overexpanded axisymmetric microjet have been investigated numerically by means of a fully coupled pressure-based shock capturing scheme. Due to the low free-stream Reynolds number (Re $\approx$ 7), the Navier-Stokes equations were coupled with slip velocity and temperature jump boundary conditions to account for rarefied gas effects in the Knudsen layer. It has been found that pronounced viscosity levels can cause a transition from a three-shock to a two-shock configuration, which is impermissible by inviscid theory. This provides novel evidence that supports recent observations for axisymmetric ring wedge intakes. Analysis of the von Neumann and detachment criteria indicates that the transition from Mach reflection to regular-like reflection is analogous to the dual-solution domain transition for planar shocks. In addition, prediction of the longitudinal curvature of the incident shock has been conducted from a mathematical standpoint.Comment: 10 pages, 11 figure

Strongly stable dual-pairing summation by parts finite difference schemes for the vector invariant nonlinear shallow water equations -- I: numerical scheme and validation

We present an energy/entropy stable and high order accurate finite difference method for solving the linear/nonlinear shallow water equations (SWE) in vector invariant form using the newly developed dual-pairing (DP) and dispersion-relation preserving (DRP) summation by parts (SBP) finite difference operators. We derive new well-posed boundary conditions for the SWE in one space dimension, formulated in terms of fluxes and applicable to linear and nonlinear problems. For nonlinear problems, entropy stability ensures the boundedness of numerical solutions, however, it does not guarantee convergence. Adequate amount of numerical dissipation is necessary to control high frequency errors which could ruin numerical simulations. Using the dual-pairing SBP framework, we derive high order accurate and nonlinear hyper-viscosity operator which dissipates entropy and enstrophy. The hyper-viscosity operator effectively tames oscillations from shocks and discontinuities, and eliminates poisonous high frequency grid-scale errors. The numerical method is most suitable for the simulations of sub-critical flows typical observed in atmospheric and geostrophic flow problems. We prove a priori error estimates for the semi-discrete approximations of both linear and nonlinear SWE. We verify convergence, accuracy and well-balanced property via the method of manufactured solutions (MMS) and canonical test problems such as the dam break, lake at rest, and a two-dimensional rotating and merging vortex problem.Comment: 32 pages, 10 figures, comments are welcom

Analytical and Numerical Study of the Non-uniformity induced Type II Asymmetric Cap Shock Mach Reflection in Over-expanded Supersonic Jets

A combined analytical and numerical study is conducted to investigate the asymmetric cap-shock non-uniform Mach Reflection (csMR) phenomenon outside of an over-expanded supersonic jet for the first time. Prior analytical works have only considered the wedge-induced steady symmetric and asymmetric Mach reflection configurations. However, there is another structure occurring in nozzle flow fields known as a non-uniformity induced cap-shock pattern. We derive a new analytical model to predict the wave structure of the asymmetric csMR in the absence of internal shocks by extending on a prior symmetric Mach reflection (MR) model. Different from the wedge flow case, flow non-uniformity is incorporated by assuming different upstream Mach numbers in both upper and lower domains, where the asymmetry is predicted through averaged flowfields and slipstream inclination angles. The numerical approach utilises an Euler solver for comparisons to the developed theory. It is found that the model adequately predicts the shock structure obtained from numerical simulations, and can be utilised for various sets of parameters to capture the direct Mach reflection (DiMR-DiMR) configuration. The von Neumann criterion is also predicted by the new analytic model, along with the Mach stem profile and shock curvatures. Based on the analytical and numerical observations, a hypothesis is also made regarding the stability of MR structures within an over-expanded jet.Comment: 33 pages, 18 figure

Fundamental MHD scales -- II: the kinematic phase of the supersonic small-scale dynamo

The small-scale dynamo (SSD) amplifies weak magnetic fields exponentially fast via kinetic motions. While there exist well-established theories for SSDs in incompressible flows, many astrophysical SSDs operate in supersonic turbulence. To understand the impact of compressibility on amplified magnetic fields, we perform an extensive set of visco-resistive SSD simulations, covering a wide range of sonic Mach number $\mathcal{M}$, hydrodynamic Reynolds number Re, and magnetic Prandtl number Pm. We develop robust methods for measuring kinetic and magnetic energy dissipation scales $\ell_\nu$ and $\ell_\eta$, as well as the scale at which magnetic fields are strongest $\ell_p$ during the kinematic phase of these simulations. We show that $\ell_\nu/\ell_\eta \sim$ Pm$^{1/2}$ is a universal feature in the kinematic phase of Pm $\geq 1$ SSDs, regardless of $\mathcal{M}$ or Re, and we confirm earlier predictions that SSDs operating in incompressible plasmas (either $\mathcal{M} \leq 1$ or Re $<$ Re$_{\rm crit} \approx 100$) concentrate magnetic energy at the smallest scales allowed by magnetic dissipation, $\ell_p \sim \ell_\eta$, and produce fields organised with field strength and field-line curvature inversely correlated. However, we show that these predictions fail for compressible SSDs ($\mathcal{M} > 1$ and Re $>$ Re$_{\rm crit}$), where shocks concentrate magnetic energy in large-scale, over-dense, coherent structures, with size $\ell_p \sim (\ell_{\rm turb} / \ell_{\rm shock})^{1/3} \ell_\eta \gg \ell_\eta$, where $\ell_{\rm shock} \sim \mathcal{M}^2 / [$Re $(\mathcal{M} - 1)^2]$ is shock width, and $\ell_{\rm turb}$ is the turbulent outer scale; magnetic field-line curvature becomes almost independent of the field strength. We discuss the implications for galaxy mergers and for cosmic-ray transport models in the interstellar medium that are sensitive to field-line curvature statistics.Comment: 25 pages, 15 figures, submitted to MNRAS, json-file w/ dat

Spatiotemporal dynamics of transonic shock-wave/turbulent-boundary-layer interactions in an overexpanded planar nozzle

We perform a combined numerical and experimental study to investigate the transonic shock-wave/turbulent-boundary-layer interactions (STBLI) in a shock-induced separated subscale planar nozzle with fully-expanded Mach number,$M_j = 1.05$ and jet Reynolds number $Re \sim 10^5$. The nozzle configuration is tested via time-resolved schlieren visualisation. While numerous studies have been conducted on the high Reynolds number separated flowfields, little is known on the weak shock wave unsteadiness present in low nozzle pressure ratio (NPR) transonic nozzles. Therefore, numerical simulations are carried out with high resolution three-dimensional delayed detached eddy simulation (DDES), to study the spatiotemporal dynamics of wall pressure signals and unsteady shock interactions. The transient statistics considered include spectral Fourier and wavelet-based analysis and dynamic mode decomposition (DMD). The spectral analyses reveal energetic low frequency modes corresponding to the staging behaviour of shock unsteadiness, and high frequencies linked to the characteristics of the Kelvin-Helmholtz instabilities in the downstream turbulent mixing layer. The mechanisms for the low frequency unsteadiness is educed through modal decomposition and spectral analysis, wherein it is found that the downstream perturbations within the separation bubble play a major role in not only closing the aeroacoustic feedback loop, but allowing the continual evolution and sustainment of low frequency unsteadiness. An analysis via the vortex sheet method is also carried out to characterise the screech production, by assuming an upstream propagating guided jet modeComment: 19 pages, 17 figures, submitted to Po

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

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

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally