We present a proof-of-concept for the adaptive mesh refinement method applied to atmospheric boundary-layer simulations. Such a method may form an attractive alternative to static grids for studies ...on atmospheric flows that have a high degree of scale separation in space and/or time. Examples include the diurnal cycle and a convective boundary layer capped by a strong inversion. For such cases, large-eddy simulations using regular grids often have to rely on a subgrid-scale closure for the most challenging regions in the spatial and/or temporal domain. Here we analyze a flow configuration that describes the growth and subsequent decay of a convective boundary layer using direct numerical simulation (DNS). We validate the obtained results and benchmark the performance of the adaptive solver against two runs using fixed regular grids. It appears that the adaptive-mesh algorithm is able to coarsen and refine the grid dynamically whilst maintaining an accurate solution. In particular, during the initial growth of the convective boundary layer a high resolution is required compared to the subsequent stage of decaying turbulence. More specifically, the number of grid cells varies by two orders of magnitude over the course of the simulation. For this specific DNS case, the adaptive solver was not yet more efficient than the more traditional solver that is dedicated to these types of flows. However, the overall analysis shows that the method has a clear potential for numerical investigations of the most challenging atmospheric cases.
Forests impact regional hydrology and climate directly by regulating water and heat fluxes. Indirect effects through cloud formation and precipitation can be important in facilitating ...continental-scale moisture recycling but are poorly understood at regional scales. In particular, the impact of temperate forest on clouds is largely unknown. Here we provide observational evidence for a strong increase in cloud cover over large forest regions in western Europe based on analysis of 10 years of 15 min resolution data from geostationary satellites. In addition, we show that widespread windthrow by cyclone Klaus in the Landes forest led to a significant decrease in local cloud cover in subsequent years. Strong cloud development along the downwind edges of larger forest areas are consistent with a forest-breeze mesoscale circulation. Our results highlight the need to include impacts on cloud formation when evaluating the water and climate services of temperate forests, in particular around densely populated areas.
Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment ...is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials.
In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature.
Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response.
KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Observations of two typical contrasting weakly stable and very stable boundary layers from the winter at Dome C station, Antarctica, are used as a benchmark for two centimetre-scale-resolution ...large-eddy simulations. By taking the Antarctic winter, the effects of the diurnal cycle are eliminated, enabling the study of the long-lived steady stable boundary layer. With its homogeneous, flat snow surface, and extreme stabilities, the location is a natural laboratory for studies on the long-lived stable boundary layer. The two simulations differ only in the imposed geostrophic wind speed, which is identified as the main deciding factor for the resulting regime. In general, a good correspondence is found between the observed and simulated profiles of mean wind speed and temperature. Discrepancies in the temperature profiles are likely due to the exclusion of radiative transfer in the current simulations. The extreme stabilities result in a considerable contrast between the stable boundary layer at the Dome C site and that found at typical mid-latitudes. The boundary-layer height is found to range from approximately
50
m
to just
5
m
in the most extreme case. Remarkably, heating of the boundary layer by subsidence may result in thermal equilibrium of the boundary layer in which the associated heating is balanced by the turbulent cooling towards the surface. Using centimetre-scale resolutions, accurate large-eddy simulations of the extreme stabilities encountered in Antarctica appear to be possible. However, future simulations should aim to include radiative transfer and sub-surface heat transport to increase the degree of realism of these types of simulations.
This study investigates the difference in land-atmosphere interactions between grassland and forest during typical heatwave conditions in order to understand the controversial results of Teuling et ...al. (2010) (hereafter T10), who found the systematic occurrence of higher sensible heat fluxes over forest than over grassland during heatwaves. With a simple but accurate coupled land-atmosphere model, we show that existing parametrizations are able to reproduce the findings of T10 for normal summer and heatwave conditions. Furthermore, we demonstrate the sensitivity of the coupled system to changes in incoming radiation and early-morning temperature typical for European heatwaves. Our results suggest that the fast atmospheric control of stomatal resistance can explain the observed differences between grassland and forest. The atmospheric boundary layer has a buffering function therein: increases in stomatal resistance are largely compensated for by increases in the potential evaporation due to atmospheric warming and drying. In order to disentangle the contributions of differences in several static and dynamic properties between forest and grassland, we have performed a virtual experiment with artificial land-use types that are equal to grassland, but with one of its properties replaced by that of forest. From these, we confirm the important role of the fast physiological processes that lead to the closure of stomata. Nonetheless, for a full explanation of T10's results, the other properties (albedo, roughness and the ratio of minimum stomatal resistance to leaf-area index) play an important but indirect role; their influences mainly consist of strengthening the feedback that leads to the closure of the stomata by providing more energy that can be converted into sensible heat. The model experiment also confirms that, in line with the larger sensible heat flux, higher atmospheric temperatures occur over forest. As our parametrization for stomatal resistance is empirical rather than mechanical, our study stresses the demand for a better mechanistic understanding of physiological processes in plants.
Land‐atmosphere feedbacks, in particular the response of land evaporation to vapor pressure deficit (VPD) or the dryness of the air, remain poorly understood. Here we investigate the VPD response by ...analysis of a large database of eddy covariance flux observations and simulations using a conceptual model of the atmospheric boundary layer. Data analysis reveals that under high VPD and corresponding high temperatures, forest in particular reduces evaporation and emits more sensible heat. In contrast, grass increases evaporation and emits less sensible heat. Simulations show that this VPD feedback can induce significant temperature increases over forest of up to 2 K during heat wave conditions. It is inferred from the simulations that the effect of the VPD feedback corresponds to an apparent soil moisture depletion of more than 50%. This suggests that previous studies may have incorrectly attributed the effects of atmospheric aridity on temperature to soil dryness.
Key Points
Diverging surface energy balance response to atmospheric aridity is found over grassland and forest
High vapor pressure deficit enhances simulated heat wave temperatures over forest by up to 2K
Vapor pressure deficit effect on temperature is similar to effect of severe soil moisture drought
Purpose
Previous studies comparing high tibial osteotomy (HTO) with unicompartmental knee arthroplasty (UKA) have seldom accounted for differing patient characteristics between both groups. This ...study compared patient-reported outcomes (PROs) of HTO and UKA patients, adjusted for preoperative PROs, osteoarthritis grade and sex.
Methods
A retrospective study was performed analysing prospectively collected PROs, namely the Oxford Knee Score (OKS) and pain/satisfaction scores, collected preoperatively and at 6 months, 12 months and 24 months postoperatively. Consecutive medial opening-wedge HTOs and medial UKAs from 2016–2019, with a preoperative Kellgren–Lawrence grade ≥ 3, aged 50–60 years, were included. Linear mixed model analyses, with the OKS over time as the primary outcome, were used.
Results
We included 84 HTO patients (mean age 55.0 ± 3.0, 79% male, mean BMI 27.8 ± 3.4, 75% Kellgren–Lawrence grade 3) and 130 UKA patients (mean age 55.7 ± 2.8, 47% male, mean BMI 28.7 ± 4.0, 36% Kellgren–Lawrence grade 3). Response rates were ≥ 87% at all time points. Corrected for preoperative PROs, Kellgren–Lawrence grade and sex, the HTO group had a 2.5 (95% CI 1.0–4.0) points lower OKS over time than the UKA group (
p
= 0.001). The Numeric Rating Scale scores (NRS; 0–10) for pain at rest and during activity were higher (
p
< 0.01) in the HTO group. The EQ-5D-descriptive system (
p
< 0.01), NRS satisfaction (
p
< 0.01), anchor function and pain scores (
p
< 0.01) were lower over time in the HTO group.
Conclusion
UKA patients had better OKS scores, pain and satisfaction scores over time than HTO patients. However, the observed differences were below their established minimal clinically important differences. Therefore, from the patients’ perspective, HTO did not appear to be inferior to UKA under the indications outlined in this study.
Level of evidence
Level IV.
Background:
High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). ...By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty.
Purpose:
To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph.
Results:
We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range IQR, 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up (P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76).
Conclusion:
More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.
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