Force Decomposition of 3D Unsteady Aerodynamics for 2 Symmetric Flapping Wings

Nowadays, the aerodynamic processes that are behind any flapping flight are not completely understood by the scientific community. Despite there are some numeri- cal methods which calculate the forces in 2D and 3D, these processes fail when they give an insight about the actual processes happening through a flapping system. In addition, these tools require a high computational time and the costs they sometimes present are very high. When flapping wings are studied, the method used is the force decomposition where the vortex structures acquire a decisive role for the development of these flights. For relevant studies, the 3D models seem to be the best option because the 2D ones do not generate results so similar to reality. For this reason, the optimum analysis for flapping wings is a 3D motion which is subjected to different kinematics and geometry conditions to see the evolution for each decomposed force. During this work, a code which computes the decomposed forces using Chang’s algorithm has been taken as a reference. This code could only compute the heaving motion for just one 3D wing. As a result of this project, it has been created a tool which is capable of computing the decomposed forces for 2 wings. In addition, though user inputs, the geometry and kinematic can be changed. The geometry by means of the Aspect Ratio and the kinematics through the radius of rotation. Once this is achieved, after the corresponding optimizations and validations, it has been studied the influence on results that a second wing could have on a first one. For this, it has been set a motion of Re=500 and reduced frequency k=1. The conclusion is that when the fluid is incompressible, there are no instabilities through the spanwise direction. As a consequence of this, the influence that the sec- ond wing has on the first one is negligible. Finally, different geometry and kinematic conditions have been presented with the same simulating conditions. Through this part, it has been analyzed the influence that the variation of these parameters has on the resultant forces. The conclusion for this analysis says that heaving motion produces a higher quantity of thrust and lift with respect the flapping one. This is due to the kinematics nature of each case. During the heaving process, the wing will move a higher quantity of air than the flapping one. Heaving motion produces constant vortex structures around the span, so it will produce a similar amount of forces over the spanwise. For the flapping case, the vortex structures decrease from the wing tip to the inboard tip, generating a smaller quantity of thrust and lift.A día de hoy, los procesos aerodinámicos que ocurren durante el vuelo de aleteo no son comprendidos en su totalidad. A pesar de que existen métodos numéricos que calculan las fuerzas en 2 y 3 dimensiones, estos procesos fallan a la hora de dar una visión de lo que realmente ocurre desde un punto de vista aerodinámico. Además estas herramientas requieren un tiempo computacional considerable y los costes suelen ser bastante elevados. En el estudio del vuelo de aleteo, el método empleado es la descomposición de fuerzas donde las estructuras vorticiales adquieren un papel decisivo en el desarrollo de estos vuelos. Para obtener resultados relevantes, los modelos tridimensionales son la mejor opción ya que aquellos en 2D no generan resultados tan similares a la realidad. Por ello, el análisis más óptimo que se puede hacer de vuelo en aleteo es un modelo en 3 dimensiones al cual se le someten diferentes tipos de movimientos y geometrías para comprobar la evolución de cada una de las fuerzas que intervienen en dicho movimiento. Este trabajo, se basa en un código que obtenía la descomposición de fuerzas utilizando el algoritmo de Chang [22]. Este código sólo admitía movimiento agitado para un único ala. El resultado de este estudio es una herramienta que permite calcular la descomposición de fuerzas para 2 alas simétricas a las que se puede someter diferentes condiciones de geometría y cinemática. La parte geométrica en el sentido del Aspect Ratio; y la parte cinemática cambiando el radio de rotación para obtener diferentes movimientos de aleteo. Una vez conseguido, tras las consiguientes optimizaciones y validaciones, se ha estudiado la influencia que una segunda ala puede tener en los resultados de las fuerzas calculadas en la primera. Para esto se ha establecido un Re=500 y una frecuencia reducida de k=1. La conclusión a la que se llega es que cuando el flujo es incompresible, para los campos vorticiales no hay inestabilidades a lo largo de la dirección de enveradura de las alas. Esto hace que la influencia de la segunda ala sobre la primera pueda considerarse despreciable. Finalmente, diferentes condiciones de geometría y cinemática se han establecido para estudiar la repercusión que estos dos parámetros pueden tener en la descomposición de fuerzas. La conclusión de este análisis dice que el movimiento agitado va a producir una mayor cantidad de empuje y sustentación respecto al vuelo en aleteo. Esto es debido a la naturaleza cinemática de cada movimiento: durante el proceso de agitado, el ala mueve mas masa de aire que el aleteo, por lo cual mayores fuerzas vorticiales se generarán en el cuerpo que más masa mueva.Ingeniería Aeroespacia

Evaluation of a program to expand use of sport education model: Teachers’ perception and experience

Although physical education (PE) is spread all around the world and the large amount of physical activity policies focused on childhood at schools, there is a big difference between policy and real-life practice at schools. The main objectives of this study were 1) to know the diffusion and main features of Sport Education at schools in Castilla-La Mancha (Spain) through the program Proyectos Escolares Saludables (PES, in English, Healthy Schools Project, HSP); 2) to know teachers’ perceptions of the impact of Sport Education in their everyday teaching practice. During three academic years (2016/2017; 2017/2018 and 2018/2019), 181 Primary and Secondary schools participated in the HSP. Data from 91 of them were analysed through an ad hoc self-report. The results showed that during the first year of permanence in the HSP, 337 seasons were implemented according to Sport Education in these 91 schools. In relation to their perception, teachers showed a positive perception of educational potential of Sport Education compared to his previous teaching practice, highlighting students’ motivation, content learning and development of responsibilities. In conclusion, the general teachers’ perception who have implemented Sport Education in Castilla-La Mancha through HSP highlights the great educational potential of this pedagogical model, as well as that the teacher training process has been adequate. In turn, the inclusion of new methodologies in school projects promoted by educational authorities seems to be an ideal means for the teachers’ professional development.This study was funded within the collaboration agreement between the Ministry of Education, Culture and Sports (JCCM) and the University of Castilla-La Mancha (UCLM) for the development of programs to promote physical activity and sport: plan of promotion of physical activity, sport and values at school age (CONV180322). Yessica Segovia, co-author of the article is the beneficiary of a predoctoral contract for the training of research staff, (I+D+i; 2018-CPUCLM-7487) capable of co-financing by the European Social Fund [2018/12504]

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

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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&lt;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&lt;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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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