SUMMARYA hierarchical multiscale framework is proposed to model the mechanical behaviour of granular media. The framework employs a rigorous hierarchical coupling between the FEM and the discrete element method (DEM). To solve a BVP, the FEM is used to discretise the macroscopic geometric domain into an FEM mesh. A DEM assembly with memory of its loading history is embedded at each Gauss integration point of the mesh to serve as the representative volume element (RVE). The DEM assembly receives the global deformation at its Gauss point from the FEM as input boundary conditions and is solved to derive the required constitutive relation at the specific material point to advance the FEM computation. The DEM computation employs simple physically based contact laws in conjunction with Coulomb's friction for interparticle contacts to capture the loading-history dependence and highly nonlinear dissipative response of a granular material. The hierarchical scheme helps to avoid the phenomenological assumptions on constitutive relation in conventional continuum modelling and retains the computational efficiency of FEM in solving large-scale BVPs. The hierarchical structure also makes it ideal for distributed parallel computing to fully unleash its predictive power. Importantly, the framework offers rich information on the particle level with direct link to the macroscopic material response, which helps to shed lights on cross-scale understanding of granular media. The developed framework is first benchmarked by a simulation of single-element drained test and is then applied to the predictions of strain localisation for sand subject to monotonic biaxial compression, as well as the liquefaction and cyclic mobility of sand in cyclic simple shear tests. It is demonstrated that the proposed method may reproduce interesting experimental observations that are otherwise difficult to be captured by conventional FEM or pure DEM simulations, such as the inception of shear band under smooth symmetric boundary conditions, non-coaxial granular response, large dilation and rotation at the edges of shear band and critical state reached within the shear band.

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The concept of the critical state in granular soils needs to make proper reference to the fabric structure that develops at critical state. This study identifies a unique property associated with the fabric structure relative to the stresses at critical state. A unique relationship between the mean effective stress and a fabric anisotropy parameter, K, defined by the first joint invariant of the deviatoric stress tensor and the deviatoric fabric tensor, is found at critical state, and is pathindependent. Numerical simulations using the discrete-element method under different loading conditions and intermediate principal stress ratios identify a unique power law for this relationship. Based on the findings, a new definition of critical state for granular media is proposed. In addition to the conditions of constant stress and unique void ratio required by the conventional critical state concept, the new definition imposes the additional constraint that K reaches a unique value at critical state. A unique spatial critical state curve in the three-dimensional space K-e-p9 is found for a granular medium, the projection of which onto the e-p9 plane turns out to be the conventional critical state line. The new critical state concept provides an important reference state for a soil to reach, based on which the key concepts in the constitutive modelling of granular media, including the choice of state parameters, dilatancy relation and non-coaxiality, are reassessed, and future exploratory topics are discussed.

The aim of this study was to determine the efficacy of immunonutrition vs standard nutrition in cancer patients treated with surgery. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, EBSCOhost, and Web of Science were searched. Sixty‐one randomized controlled trials were included. Immunonutrition was associated with a significantly reduced risk of postoperative infectious complications (risk ratio [RR] 0.71 [95% CI, 0.64–0.79]), including a reduced risk of wound infection (RR 0.72 [95% CI, 0.60–0.87]), respiratory tract infection (RR 0.70 [95% CI, 0.59–0.84]), and urinary tract infection (RR 0.69 [95% CI, 0.51–0.94]) as well as a decreased risk of anastomotic leakage (RR 0.70 [95% CI, 0.53–0.91]) and a reduced hospital stay (MD −2.12 days [95% CI −2.72 to −1.52]). No differences were found between the 2 groups with regard to sepsis or all‐cause mortality. Subgroup analyses revealed that receiving arginine + nucleotides + ω‐3 fatty acids and receiving enteral immunonutrition reduced the rates of wound infection and respiratory tract infection. The application of immunonutrition at 25–30 kcal/kg/d for 5–7 days reduced the rate of respiratory tract infection. Perioperative immunonutrition reduced the rate of wound infection. For malnourished patients, immunonutrition shortened the hospitalization time. Therefore, immunonutrition reduces postoperative infection complications and shortens hospital stays but does not reduce all‐cause mortality. Patients who are malnourished before surgery who receive arginine + nucleotides + ω‐3 fatty acids (25–30 kcal/kg/d) via the gastrointestinal tract during the perioperative period (5–7 days) may show better clinical efficacy.

Abstract. The Box-Jenkins approach was used to fit an autoregressive integrated moving average (ARIMA) model to the incidence of hemorrhagic fever with renal Syndrome (HFRS) in China during 1986-2009. The ARIMA (0, 1, 1) + (2, 1, 0) 12 models fitted exactly with the number of cases during January 1986-December 2009. The fitted model was then used to predict HFRS incidence during 2010, and the number of cases during January-December 2010 fell within the model's confidence interval for the predicted number of cases in 2010. This finding suggests that the ARIMA model fits the fluctuations in HFRS frequency and it can be used for future forecasting when applied to HFRS prevention and control.

This paper presents a multiscale investigation on the interplay among inherent anisotropy, fabric evolution and strain localisation in granular soils, based on a hierarchical multiscale framework with rigorous coupling of the finite-element method (FEM) and discrete-element method (DEM). DEM assemblies with elongated particles are generated to simulate inherent anisotropy and are embedded to the Gauss points of the FEM mesh to derive the required constitutive relation. Specimens prepared with different bedding plane angles are subjected to biaxial shear under either smooth or rough loading platens. Key factors and physical mechanisms contributing towards the occurrence and development of strain localisation are examined. The competing evolutions of two sources of anisotropy, one related to particle orientations and the other related to contact normals, are found to underpin the development of the shear band. A single band pattern is observed under smooth boundary conditions, and its orientation relative to the bedding plane depends critically on the relative dominance between the two anisotropies. Under rough boundary conditions, the non-coaxial material response and the boundary constraint jointly lead to cross-shaped double shear bands. The multiscale simulations indicate that the DEM assemblies inside the shear band(s) undergo extensive shearing, fabric evolution and particle rotation, and may reach the critical state, while those located outside the shear band(s) experience mild loading followed by unloading. The particle-orientation-based fabric anisotropy needs significantly larger shear and dilation for mobilisation than the contact-normal based one. The asynchrony in evolution of the two fabric anisotropies can cause non-coaxial responses for initially coaxial packings, which directly triggers strain localisation.

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