On computing the jump condition of the dissipation rate in the two-equation turbulence models for two-phase flow and application to air-water waves

Traditional turbulence models are derived for single-phase flow. Extension of the family of two-equation turbulence models for two-phase flow is obtained via scaling the transport equations by the density. In the special case of two-phase flow with a sharp interface, jump conditions exist. Two types of jump conditions are found: (1) jump in the partial differential equation (PDE) physical quantities such as density and viscosity and (2) jump in the turbulence frequency. We first derive and clarify the jump in the equations. The jump in the turbulence frequency is proportional to the kinematic viscosity ratio, which is approximately $10$ in the case of air-water. Then a new field, the inverse turbulence area, is considered to model the turbulence effects instead of the turbulence frequency. For the system of air and water, the effect of the jump of the kinematic viscosity is always greater than the effect arising from the jump of velocity gradient. This approximation leads to the assumption of a continuous inverse turbulence area scale. Validation versus experimental measurements from the literature is then presented to demonstrate the improvement of the model. In particular, the wave breaking phenomenon is simulated in two conditions: spilling and plunging wave breakers. The proposed model shows its ability to predict the turbulence in the surf zone accurately. Finally, it explains the low values of the time-averaged turbulent kinetic energy in the surf zone which is caused by the increase of the turbulence frequency in the air

Brivaracetam to Treat Partial Onset Seizures in Adults.

PURPOSE OF REVIEW: Seizures are a hyperexcitable, and hypersynchronous imbalance between excitatory and inhibitory factors (E/I imbalance) in neurotransmission, and epilepsy is the recurrent manifestation of seizures within a reasonable time frame and without being attributable to a reversible cause. Brivaracetam is a derivative of the antiepileptic agent, levetiracetam, that is used as adjuvant therapy for focal onset seizures. It was approved by the FDA in 2016 and has shown promising results with minimal adverse effect reactions in clinical trials. RECENT FINDINGS: Brivaracetam has been used in multiple clinical trials at various dosages in adults that have partial-onset seizures refractory to conventional treatment. A meta-analysis in 2016 showed that brivaracetam as adjunctive therapy was statically significant in its reduction of adults with drug-refractory seizure frequency. CONCLUSION: The treatment of epilepsy with pharmacologic agents is a difficult task due to balancing the efficacy of the drug with the side effect profile that will allow for the best quality of life for the patient. There are approximately 30 antiepileptic agents for clinicians to choose from. Brivaracetam is a novel antiepileptic agent that was approved for use by the FDA in 2016 and is showing promising results as monotherapy and adjunctive therapy in individuals with drug-refractory focal seizures while minimizing adverse drug reactions

Computational Analysis of Pulsed Radiofrequency Ablation in Treating Chronic Pain

In this paper, a parametric study has been conducted to evaluate the effects of frequency and duration of the short burst pulses during pulsed radiofrequency ablation (RFA) in treating chronic pain. Affecting the brain and nervous system, this disease remains one of the major challenges in neuroscience and clinical practice. A two-dimensional axisymmetric RFA model has been developed in which a single needle radiofrequency electrode has been inserted. A finite-element-based coupled thermo-electric analysis has been carried out utilizing the simplified Maxwell’s equations and the Pennes bioheat transfer equation to compute the electric field and temperature distributions within the computational domain. Comparative studies have been carried out between the continuous and pulsed RFA to highlight the significance of pulsed RFA in chronic pain treatment. The frequencies and durations of short burst RF pulses have been varied from 1 Hz to 10 Hz and from 10 ms to 50 ms, respectively. Such values are most commonly applied in clinical practices for mitigation of chronic pain. By reporting such critical input characteristics as temperature distributions for different frequencies and durations of the RF pulses, this computational study aims at providing the first-hand accurate quantitative information to the clinicians on possible consequences in those cases where these characteristics are varied during the pulsed RFA procedure. The results demonstrate that the efficacy of pulsed RFA is significantly dependent on the duration and frequency of the RF pulses

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

Defining the industrial and engineering management professional profile: a longitudinal study based on job advertisements

The engineering professional profiles have been discussed by several branches of the engineering field. On the one hand, this discussion helps to understand the professional practice and contributes to the specification of the competences that are suitable for each function and company culture. On the other hand, it is an essential starting point for the definition of curricula in engineering schools. Thus, this study aims to characterize, in an innovative way based on job advertisements, the demand for competences and areas of practice for Industrial Engineering and Management contributing for the definition of a professional profile. This characterization is based on the analysis of 1391 job advertisements, collected during seven years from a Portuguese newspaper. The data analysis takes into account the job description in which two categories were considered: areas of professional practice (e.g. project management) and transversal competences (e.g. teamwork). Considering the total number of job advertisements, it was possible to identify 1,962 cumulative references for 11 professional practice areas and 5,261 cumulative references for transversal competences. The contribution of this study lies on the identification of the main areas of practice and the main transversal competences demanded by employers.This work was partially funded by COMPETE-POCI-01-0145-FEDER-007043 and FCT-UID-CEC-00319-2013

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