Particle collisions and coalescence in fluids

Coagulation, in the physical context, is looked upon here first from the fundamental perspective of collision and coalescence of individual particles. A Monte Carlo technique is used to investigate the particle size distribution in a suspension of coagulating particles when one or more collision mechanisms operate. The effect of interparticle forces - hydrodynamic, van der Waals' and electrostatic - on the collision probability of the particles is examined. The results obtained are used to evaluate the well-known dynamic equilibrium hypothesis according to which an equilibrium particle size distribution is assumed to exist under the action of a given collision mechanism. It is shown that dimensional analysis cannot, in general, be used to predict steady state particle size distributions, mainly because of the strong dependence of the interparticle forces on the sizes of the interacting particles. The insight into particle kinetics thus gained from the Monte Carlo simulation of collision processes is used to develop a numerical simulation of a rectangular settling basin. The computer model follows the spatial and temporal development of the influent particle size distribution towards the outlet of the tank, accounting for all of the basic kinetics of particle collision and coalescence processes and including transport processes such as particle settling, advection, resuspension and turbulent mixing. The influence of the particle size-density relationship and floc deaggregation by turbulent shearing are also modeled. Of necessity, modeling of some of these processes has been somewhat empirical since the physical and biochemical nature of the flocs are unique to a particular suspension and their determination requires experimental work. The results of the simulations performed indicate that the particle size-density relationship, the collision efficiencies between flocs and the influent particle size distribution are of major importance to the performance of the sedimentation basin. Clearly, further modifications, Improvements and trials are needed in order to use the model for the design of new facilities. Nevertheless, the computer model may serve as a guide for selection of several design and operation variables for the successful treatment of a particular waste or the selective removal of pollutants whose concentration depends on the shape of the effluent particle size distribution

Collision efficiencies of diffusing spherical particles: hydrodynamic, van der Waals and electrostatic forces

A practical limitation of the application of Smoluchowski's classical estimate for the collisions probability of two diffusing spherical particles in Brownian motion is the non-consideration of interparticle forcves. For suspended particles in water such forces can arise from the disturbance the particle causes in the fluid (hydrodynamic forces), from the cloud of ions which surround an electrically charged particle (double layer forces) or they can be of molecular origin (van der Waals forces). In this paper corrections to Smoluckhowski's collision probability are computed when such forces operate Scoluchowski's collision probability are computed when such forces operate between two approaching particles of various sizes. Results for several values of the van der Waals energy of attraction and the ionic strength of the electrolyte are presented in a way convenient for particle collision modeling

Monte Carlo simulation of coagulation in discrete particle-size distributions. Part 2. Interparticle forces and the quasi-stationary equilibrium hypothesis

Hunt (1982) and Friedlander (1960a, b) used dimensional analysis to derive expressions for the steady-state particle-size distribution in aerosols and hydrosols. Their results were supported by the Monte Carlo simulation of a non-interacting coagulating population of suspended spherical particles developed by Pearson, Valioulis & List (1984). Here the realism of the Monte Carlo simulation is improved by accounting for the modification to the coagulation rate caused by van der Waals', electrostatic and hydrodynamic forces acting between particles. The results indicate that the major hypothesis underlying the dimensional reasoning, that is, collisions between particles of similar size are most important in determining the shape of the particle size distribution, is valid only for shear-induced coagulation. It is shown that dimensional analysis cannot, in general, be used to predict equilibrium particle-size distributions, mainly because of the strong dependence of the interparticle force on the absolute and relative size of the interacting particles

Monte Carlo simulation of coagulation in discrete particle-size distributions. Part 1. Brownian motion and fluid shearing

A method for the Monte Carlo simulation, by digital computer, of the evolution of a colliding and coagulating population of suspended particles is described. Collision mechanisms studied both separately and in combination are: Brownian motion of the particles, and laminar and isotropic turbulent shearing motions of the suspending fluid. Steady-state distributions are obtained by adding unit-size particles at a constant rate and removing all particles once they reach a preset maximum volume. The resulting size distributions are found to agree with those obtained by dimensional analysis (Hunt 1982)

Outcome of alimentary tract duplications operated on by minimally invasive surgery: a retrospective multicenter study by the GECI (Groupe d'Etude en Coeliochirurgie Infantile).

BACKGROUND: Alimentary tract duplications (ATD) are a rare cause of intestinal obstruction in childhood. There are many case reports but few series about laparoscopy or thoracoscopy for ATD. The aim of our study was to report the outcome of minimally invasive surgery (MIS) for ATD. METHODS: This was a retrospective multicenter study from the GECI (Groupe d\u27Etude en Coeliochirurgie Infantile). We reviewed the charts of 114 patients operated on by MIS for ATD from 1994 to 2009. RESULTS: Sixty-two patients (54 %) had a prenatal diagnosis. Forty-nine patients (43 %) were symptomatic before surgery: 33 of those patients (63 %) with postnatal diagnosis compared to 16 (25 %) with prenatal diagnosis (P < 0.01). In this last group, the median age at onset of symptoms was 16 days (range = 0-972). One hundred and two patients had laparoscopy (esophageal to rectal duplications) and 12 patients had thoracoscopy for esophageal duplications. The mean operative time was 90 min (range = 82-98). There were 32 (28 %) resection anastomoses, 55 (48 %) enucleations, and 27 (24 %) unroofings. The conversion rate was 32 %, and in a multivariate analysis, it was significantly higher, up to 41 % for patients weighing <10 kg (P < 0.01). Ten patients (8 %) had unintentional perioperative opening of the digestive tract during the dissection. Eight patients had nine postoperative complications, including six small bowel obstructions. The median length of hospital stay was 4 days (range = 1-21) without conversion and 6 days (range = 1-27) with conversion (P = 0.01). The median follow-up was 3 months (range = 1-120). Eighteen of the 27 patients who underwent partial surgery had an ultrasound examination during follow-up. Five (18 %) of them had macroscopic residue. CONCLUSION: This study showed that MIS for ATD is feasible with a low rate of complications. Patients with prenatal diagnosis should have prompt surgery to prevent symptoms, despite a high rate of conversion in small infants

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