A coupled finite volume and material point method for two-phase simulation of liquid-sediment and gas-sediment flows

Mixtures of fluids and granular sediments play an important role in many industrial, geotechnical, and aerospace engineering problems, from waste management and transportation (liquid--sediment mixtures) to dust kick-up below helicopter rotors (gas--sediment mixtures). These mixed flows often involve bulk motion of hundreds of billions of individual sediment particles and can contain both highly turbulent regions and static, non-flowing regions. This breadth of phenomena necessitates the use of continuum simulation methods, such as the material point method (MPM), which can accurately capture these large deformations while also tracking the Lagrangian features of the flow (e.g.\ the granular surface, elastic stress, etc.). Recent works using two-phase MPM frameworks to simulate these mixtures have shown substantial promise; however, these approaches are hindered by the numerical limitations of MPM when simulating pure fluids. In addition to the well-known particle ringing instability and difficulty defining inflow/outflow boundary conditions, MPM has a tendency to accumulate quadrature errors as materials deform, increasing the rate of overall error growth as simulations progress. In this work, we present an improved, two-phase continuum simulation framework that uses the finite volume method (FVM) to solve the fluid phase equations of motion and MPM to solve the solid phase equations of motion, substantially reducing the effect of these errors and providing better accuracy and stability for long-duration simulations of these mixtures

Characteristics of the Quiet-Time Hot Spot GravityWaves Observed by GOCE Over the Southern Andes on 5 July 2010

We analyze quiet-time data from the Gravity Field and Ocean Circulation Explorer satellite as it overpassed the Southern Andes at z≃275 km on 5 July 2010 at 23 UT. We extract the 20 largest traveling atmospheric disturbances from the density perturbations and cross-track winds using Fourier analysis. Using gravity wave (GW) dissipative theory that includes realistic molecular viscosity, we search parameter space to determine which hot spot traveling atmospheric disturbances are GWs. This results in the identification of 17 GWs having horizontal wavelengths λH = 170–1,850 km, intrinsic periods τIr = 11–54 min, intrinsic horizontal phase speeds cIH = 245–630 m/s, and density perturbations (Formula presented.) 0.03–7%. We unambiguously determine the propagation direction for 11 of these GWs and find that most had large meridional components to their propagation directions. Using reverse ray tracing, we find that 10 of these GWs must have been created in the mesosphere or thermosphere. We show that mountain waves (MWs) were observed in the stratosphere earlier that day and that these MWs saturated at z∼ 70–75 km from convective instability. We suggest that these 10 Gravity Field and Ocean Circulation Explorer hot spot GWs are likely tertiary (or higher-order) GWs created from the dissipation of secondary GWs excited by the local body forces created from MW breaking. We suggest that the other GW is likely a secondary or tertiary (or higher-order) GW. This study strongly suggests that the hot spot GWs over the Southern Andes in the quiet-time middle winter thermosphere cannot be successfully modeled by conventional global circulation models where GWs are parameterized and launched in the troposphere or stratosphere. ©2019. The Authors

Large mesospheric ice particles at exceptionally high altitudes

We here report on the characteristics of exceptionally high Noctilucent clouds (NLC) that were detected with rocket photometers during the ECOMA/MASS campaign at Andøya, Norway 2007. The results from three separate flights are shown and discussed in connection to lidar measurements. Both the lidar measurements and the large difference between various rocket passages through the NLC show that the cloud layer was inhomogeneous on large scales. Two passages showed a particularly high, bright and vertically extended cloud, reaching to approximately 88 km. Long time series of lidar measurements show that NLC this high are very rare, only one NLC measurement out of thousand reaches above 87 km. The NLC is found to consist of three distinct layers. All three were bright enough to allow for particle size retrieval by phase function analysis, even though the lowest layer proved too horizontally inhomogeneous to obtain a trustworthy result. Large particles, corresponding to an effective radius of 50 nm, were observed both in the middle and top of the NLC. The present cloud does not comply with the conventional picture that NLC ice particles nucleate near the temperature minimum and grow to larger sizes as they sediment to lower altitudes. Strong up-welling, likely caused by gravity wave activity, is required to explain its characteristics

The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study.

Background:Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty. Purpose/Hypothesis:The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures. Study Design:Cross-sectional study; Level of evidence, 3. Methods:As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain. Results:The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; P < .001) and were more likely to be female (25.3% vs 17.4%; P = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) (P < .001), more frequent depression (22.2% vs 8.3%; P < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) (P < .01), and worse preoperative expectations (P < .01). Conclusion:Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient's preoperative state but also postoperative pain control and/or postoperative outcomes

Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion Cost-Effectiveness Analysis

Background and Purpose-This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods-A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, an

Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations

Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients