Design of Optimum Ducts Using an Efficient 3-D Viscous Computational Flow Analysis

Design of fluid dynamically efficient ducts is addressed through the combination of an optimization analysis with a three-dimensional viscous fluid dynamic analysis code. For efficiency, a parabolic fluid dynamic analysis was used. Since each function evaluation in an optimization analysis is a full three-dimensional viscous flow analysis requiring 200,000 grid points, it is important to use both an efficient fluid dynamic analysis and an efficient optimization technique. Three optimization techniques are evaluated on a series of test functions. The Quasi-Newton (BFGS, eta = .9) technique was selected as the preferred technique. A series of basic duct design problems are performed. On a two-parameter optimization problem, the BFGS technique is demonstrated to require half as many function evaluations as a steepest descent technique

Reconciling Simulated and Observed Views of Clouds: MODIS, ISCCP, and the Limits of Instrument Simulators in Climate Models

The properties of clouds that may be observed by satellite instruments, such as optical depth and cloud top pressure, are only loosely related to the way clouds are represented in models of the atmosphere. One way to bridge this gap is through "instrument simulators," diagnostic tools that map the model representation to synthetic observations so that differences between simulator output and observations can be interpreted unambiguously as model error. But simulators may themselves be restricted by limited information available from the host model or by internal assumptions. This work examines the extent to which instrument simulators are able to capture essential differences between MODIS and ISCCP, two similar but independent estimates of cloud properties. We focus on the stark differences between MODIS and ISCCP observations of total cloudiness and the distribution of cloud optical thickness can be traced to different approaches to marginal pixels, which MODIS excludes and ISCCP treats as homogeneous. These pixels, which likely contain broken clouds, cover about 15% of the planet and contain almost all of the optically thinnest clouds observed by either instrument. Instrument simulators can not reproduce these differences because the host model does not consider unresolved spatial scales and so can not produce broken pixels. Nonetheless, MODIS and ISCCP observation are consistent for all but the optically-thinnest clouds, and models can be robustly evaluated using instrument simulators by excluding ambiguous observations

Reconciling Simulated and Observed Views of Clouds: MODIS, ISCCP, and the Limits or Instrument Simulators

The properties of clouds that may be observed by satellite instruments, such as optical depth and cloud top pressure, are only loosely related to the way clouds m-e represented in models of the atmosphere. One way to bridge this gap is through "instrument simulators," diagnostic tools that map the model representation to synthetic observations so that differences between simulator output and observations can be interpreted unambiguously as model error. But simulators may themselves be restricted by limited information available from the host model or by internal assumptions. This paper considers the extent to which instrument simulators are able to capture essential differences between MODIS and ISCCP, two similar but independent estimates of cloud properties. The authors review the measurements and algorithms underlying these two cloud climatologies, introduce a MODIS simulator, and detail data sets developed for comparison with global models using ISCCP and MODIS simulators, In nature MODIS observes less mid-level doudines!> than ISCCP, consistent with the different methods used to determine cloud top pressure; aspects of this difference are reproduced by the simulators running in a climate modeL But stark differences between MODIS and ISCCP observations of total cloudiness and the distribution of cloud optical thickness can be traced to different approaches to marginal pixels, which MODIS excludes and ISCCP treats as homogeneous. These pixels, which likely contain broken clouds, cover about 15 k of the planet and contain almost all of the optically thinnest clouds observed by either instrument. Instrument simulators can not reproduce these differences because the host model does not consider unresolved spatial scales and so can not produce broken pixels. Nonetheless, MODIS and ISCCP observation are consistent for all but the optically-thinnest clouds, and models can be robustly evaluated using instrument simulators by excluding ambiguous observations

Measuring troublesomeness of chronic pain by location

Background Current measures of pain assess the relative contribution of pain in different body regions to the overall impact of pain. We developed a series of questions to measure the relative 'troublesomeness' of pain in different body regions (the "troublesomeness grid"). The study aimed to determine whether the "troublesomeness grid" is an appropriate measure to assess the severity of pain in different body regions, allowing the comparative severity of pain in different body regions to be assessed. Methods We used data from a pilot for a population survey of pain (N = 205) and from the population survey itself (N = 2504) to assess the 'troublesomeness grid's performance. Specifically, its face and content validity using overall and item non-completion rates; its criterion related validity by exploring the relationship between troublesomeness and standard measures of pain, disability, distress and health utility for the five body regions most commonly affected by chronic pain; and its reliability and reproducibility in a test/re-test study. Results The troublesomeness grid appeared to have good face validity as it had good completion rates. It also appeared to have good content validity as the percentage agreement between the grid and the pain manikin was high (over 90%). In terms of criterion related validity, troublesomeness was most strongly correlated with pain intensity and health related quality of life, but less with disability and distress. The test-retest reliability was between 80% and 90% for the majority of body regions examined. Conclusion The troublesomeness grid is well completed and appears to be an appropriate tool to assess the comparative severity of pain in different body regions

Effects of Cloud Horizontal Inhomogeneity and Drizzle on Remote Sensing of Cloud Droplet Effective Radius: Case Studies Based on Large-eddy Simulations

This study investigates effects of drizzle and cloud horizontal inhomogeneity on cloud effective radius (re) retrievals from the Moderate Resolution Imaging Spectroradiometer (MODIS). In order to identify the relative importance of various factors, we developed a MODIS cloud property retrieval simulator based on the combination of large-eddy simulations (LES) and radiative transfer computations. The case studies based on synthetic LES cloud fields indicate that at high spatial resolution (100 m) 3-D radiative transfer effects, such as illumination and shadowing, can induce significant differences between retrievals ofre based on reflectance at 2.1 m (re,2.1) and 3.7 m (re,3.7). It is also found that 3-D effects tend to have stronger impact onre,2.1 than re,3.7, leading to positive difference between the two (re,3.72.1) from illumination and negative re,3.72.1from shadowing. The cancellation of opposing 3-D effects leads to overall reasonable agreement betweenre,2.1 and re,3.7 at high spatial resolution as far as domain averages are concerned. At resolutions similar to MODIS, however, re,2.1 is systematically larger than re,3.7when averaged over the LES domain, with the difference exhibiting a threshold-like dependence on bothre,2.1and an index of the sub-pixel variability in reflectance (H), consistent with MODIS observations. In the LES cases studied, drizzle does not strongly impact reretrievals at either wavelength. It is also found that opposing 3-D radiative transfer effects partly cancel each other when cloud reflectance is aggregated from high spatial resolution to MODIS resolution, resulting in a weaker net impact of 3-D radiative effects onre retrievals. The large difference at MODIS resolution between re,3.7 and re,2.1 for highly inhomogeneous pixels with H 0.4 can be largely attributed to what we refer to as the plane-parallelrebias, which is attributable to the impact of sub-pixel level horizontal variability of cloud optical thickness onre retrievals and is greater for re,2.1 than re,3.7. These results suggest that there are substantial uncertainties attributable to 3-D radiative effects and plane-parallelre bias in the MODIS re,2.1retrievals for pixels with strong sub-pixel scale variability, and theH index can be used to identify these uncertainties

Cognitive and affective reassurance and patient outcomes in primary care:a systematic review

In the context of uncertainty about aetiology and prognosis, good clinical practice commonly recommends both affective (creating rapport, showing empathy) and cognitive reassurance (providing explanations and education) to increase self-management in groups with nonspecific pain conditions. The specific impact of each of these components in reference to patients' outcomes has not been studied. This review aimed to systematically evaluate the evidence from prospective cohorts in primary care that measured patient-practitioner interactions with reference to patient outcomes. We carried out a systematic literature search and appraisal of study methodology. We extracted measures of affective and cognitive reassurance in consultations and their associations with consultation exit and follow-up measures of patients' outcomes. We identified 16 studies from 16,059 abstracts. Eight studies were judged to be high in methodological quality. Pooling could not be achieved as a result of heterogeneity of samples and measures. Affective reassurance showed inconsistent findings with consultation exit outcomes. In 3 high-methodology studies, an association was found between affective reassurance and higher symptom burden and less improvement at follow-up. Cognitive reassurance was associated with higher satisfaction and enablement and reduced concerns directly after the consultations in 8 studies; with improvement in symptoms at follow-up in 7 studies; and with reduced health care utilization in 3 studies. Despite limitations, there is support for the notion that cognitive reassurance is more beneficial than affective reassurance. We present a tentative model based on these findings and propose priorities for future research. © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved

Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures

Objective: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work.Methods: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with “clinical scaphoid fracture”: a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days.Results: Eighty patients completed the study protocol in a regional emergency department.In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days) and had no or minimal time off work (mean 1.6 days). Patient satisfaction was an average 4.2/5.Conclusion: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients.[WestJEM. 2009;10(4):227-232.

Predicting response to leuprolide of women with premenstrual dysphoric disorder by daily mood rating dynamics

Approximately 60–70 percent of women with premenstrual dysphoric disorder (PMDD) show symptomatic improvement in response to the GnRH agonist leuprolide acetate, which suppresses ovarian function. However, it has been very difficult to either predict or understand why some women respond, while others do not. We applied several complementary statistical methods to the dynamics of pre-treatment mood rating data to determine possible predictors of response for women with PMDD. We compared responders (n = 33) to nonresponders (n = 12) in clinical trials of leuprolide (three months in duration) as a treatment for PMDD, on the basis of pre-trial daily self-ratings of sadness, anxiety, and irritability. We analyzed both sequential irregularity (approximate entropy, ApEn) and a quantification of spikiness of these series, as well as a composite measure that equally weighted these two statistics. Both ApEn and Spikiness were significantly smaller for responders than nonresponders (P ≤ 0.005); the composite measure was smaller for responders compared with nonresponders (P ≤ 0.002) and discriminated between the subgroups with high sensitivity and specificity. In contrast, mean symptom levels were indistinct between the subgroups. Relatively regular and non-spiky pre-trial dynamics of mood ratings predict a positive response to leuprolide by women with PMDD with high probability, moreover based on typically less than 3 months of daily records. The statistical measures may have broad and direct applicability to behavioral studies for many psychiatric disorders, facilitating both accurate diagnosis and the prediction of response to treatment