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Research article Topical Sections

Geriatric oral health competency among dental providers

  • Background 

    Geriatrics as an educational topic has been a high priority in current health care. The innovative Age-Friendly health system with the 4Ms structure (what Matters most, Medication, Mentation, Mobility) needs to be integrated into oral health and dental services training. The purpose of this study is to respond to one question: are the graduating general dentists trained and prepared to treat medically vulnerable elderly in communities?

    Methods 

    All pre-doctorate dental students from first year to fourth year were invited to voluntarily respond to an online survey provided on Qualtrics. The survey provided examples of two broken molar teeth that need extraction. First, students were asked how comfortable they felt extracting the two molars based on the x-rays. Then, the question was repeated to evaluate if they felt comfortable with extracting the teeth in a patient with one chronic condition and related medication(s). Finally, the students were again questioned whether they feel comfortable to provide the same service to medically vulnerable patients with multiple health conditions and polypharmacy.

    Results 

    The majority of students who participated in this study said they were comfortable with extracting the teeth of patients without any chronic condition. However, many more chose to refer medically vulnerable patients with multiple chronic conditions and polypharmacy to a specialist.

    Conclusions 

    Dental education in many U.S. dental schools may provide adequate education and create competent general dentists. Yet, the competency and confidence required for dentists to be able to treat older adults with multiple health conditions and using prescribed or over-the-counter medication is insufficient.

    Citation: Maryam Tabrizi, Wei-Chen Lee. Geriatric oral health competency among dental providers[J]. AIMS Public Health, 2021, 8(4): 682-690. doi: 10.3934/publichealth.2021054

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  • Background 

    Geriatrics as an educational topic has been a high priority in current health care. The innovative Age-Friendly health system with the 4Ms structure (what Matters most, Medication, Mentation, Mobility) needs to be integrated into oral health and dental services training. The purpose of this study is to respond to one question: are the graduating general dentists trained and prepared to treat medically vulnerable elderly in communities?

    Methods 

    All pre-doctorate dental students from first year to fourth year were invited to voluntarily respond to an online survey provided on Qualtrics. The survey provided examples of two broken molar teeth that need extraction. First, students were asked how comfortable they felt extracting the two molars based on the x-rays. Then, the question was repeated to evaluate if they felt comfortable with extracting the teeth in a patient with one chronic condition and related medication(s). Finally, the students were again questioned whether they feel comfortable to provide the same service to medically vulnerable patients with multiple health conditions and polypharmacy.

    Results 

    The majority of students who participated in this study said they were comfortable with extracting the teeth of patients without any chronic condition. However, many more chose to refer medically vulnerable patients with multiple chronic conditions and polypharmacy to a specialist.

    Conclusions 

    Dental education in many U.S. dental schools may provide adequate education and create competent general dentists. Yet, the competency and confidence required for dentists to be able to treat older adults with multiple health conditions and using prescribed or over-the-counter medication is insufficient.



    Chemotaxis is a biological phenomenon which describes the oriented movement of cells (or organisms) in response to chemical gradients [1,2]. As early as 1970, Keller and Segel [3] originally introduced a chemotaxis model through a system of parabolic equations. This model reads

    {nt=Δn(nS(x,n,c)c),xΩ,t>0,ct=Δcc+n,xΩ,t>0, (1.1)

    where ΩRN is a bounded domain with smooth boundary, the unknown functions n and c respectively represent the cell density and the signal concentration, and S denotes the chemotactic sensitivity. This model is primarily used to describe the aggregation phenomenon of Dictyostelium discoideum, where the effects of the chemical signal secreted by themselves are taken into consideration. During the past half a century, the Keller-Segel model has been attracting many scholars' attention. The known results are concentrated on whether the solutions for Neumann boundary problem of (1.1) globally exist or blow up in finite time. Concretely, if S:=S(n) is a scalar function fulfilling S(n)CS(n+1)α with some CS>0 and α>0, then for all α>12N, the corresponding problem has a global solution which is uniformly bounded [4]. However, if S satisfies S(n)>cSnα with some cS>0 and α<12N for N2, and Ω is a ball, then the solution of (1.1) will blow up in finite time. So,

    α=N2N

    is called the critical exponent of the blow-up phenomenon. Recently, some results relating to the well-posedness of the hyperbolic Keller-Segel equation in the Besov framework were obtained in [5]. Afterwards, Zhang et al. [6] improved these results and established two kinds of blow-up criteria of strong solutions in Besov spaces by means of Littlewood-Paley theory. For more results about (1.1) and its variations, we refer interested readers to [7,8,9,10,11,12,13,14,15,16]

    If we consider the framework where the chemical is produced by the cells indirectly, the corresponding chemotaxis model turns to the following Keller-Segel system with indirect signal production:

    {nt=Δn(nS(x,n,v,w)v),xΩ,t>0,vt=Δvv+w,xΩ,t>0,wt=Δww+n,xΩ,t>0, (1.2)

    in a bounded domain ΩRN with smooth boundary, where the functions n, v and w represent the cells, density, the signal and the chemical concentration, respectively. If S(x,n,v,w)=χ with χ>0 and N3, Fujie and Senba [17] showed that the homogeneous Neumann (or mixed) boundary problem of system (1.2) possesses a unique and globally bounded classical solution.

    However, in many cases, the migration of cells (or bacteria) is largely affected by their surrounding environment [18,19]. If the cells consume the chemical signal, Tuval et al. [19] introduced the following chemotaxis-fluid system:

    {nt+un=Δn(nS(x,n,c)c),xΩ,t>0,ct+uc=Δcnf(c),xΩ,t>0,ut+κ(u)u+P=Δu+nϕ,xΩ,t>0,u=0,xΩ,t>0, (1.3)

    in a bounded domain ΩR3 with smooth boundary, where f(c) measures the rate that cells consume the oxygen, and S(x,n,c) is a tensor-valued (or scalar) chemotactic sensitivity. Most remarkably, by means of the chemical consumption setting and the maximum principle of the parabolic equations, we may directly deduce that c is uniformly bounded from the second equation of (1.3). This significant feature leads to the chemotaxis-fluid model with the framework of signal consumption being more intensively studied than the signal production mechanism. For instance, Winkler [20] proved that the global weak solution of system (1.3) which has enough regularity properties and thereby fulfills the condition of so-called eventual energy solution (this concept is newly proposed in his paper) becomes eventually smooth after some waiting time. For more studies about this system, one can refer to Zheng [21], Winkler [22,23,24,25] and other results on the global solvability and asymptotic behavior, such as [26,27,28], for details.

    Considering the framework where the chemical signal is produced by the cells instead of consuming it, the corresponding chemotaxis-fluid model becomes the following Keller-Segel(-Navier)-Stokes system:

    {nt+un=Δn(nS(x,n,c)c),xΩ,t>0,ct+uc=Δcc+n,xΩ,t>0,ut+κ(u)u+P=Δu+nϕ,xΩ,t>0,u=0,xΩ,t>0, (1.4)

    where S is a tensor-valued (or scalar) function, and ΩRN with smooth boundary. Let us just list a few representative results. For the Navier-Stokes fluid (i.e. κ0), if |S(x,n,c)|CS(n+1)α with CS>0 and α>0, in 2D case Wang et al. [29] showed that the initial-boundary value problem of (1.4) admits at least one classical solution. In the 3D Stokes case (i.e. κ=0) of (1.4), Wang and Xiang [30] got the same results for α>12. For the 3D Navier-Stokes version of system (1.4), Liu and Wang [31] verified that there exists at least one global weak solution for the corresponding initial-boundary value problem of (1.4) if |S(x,n,c)|CS(n+1)α with some CS>0 and α>37. Recently, Ke and Zheng [32] improved the restriction admitting a global weak solution from α>37 to α>13, which compared with the known result of the fluid-free system is an optimal restriction on α. As for the further results, under assumption α1 and an explicit condition on the size of CS, Zheng [33] confirmed that the weak solution of system (1.4) would be eventually smooth, and that it is close to a unique spatially homogeneous steady state. Additionally, one can see [34,35,36] and the references therein to find more conclusions about this system.

    Motivated by the above works, in this paper we consider the following initial-boundary value problem of the Keller-Segel-Navier-Stokes system with indirect signal production:

    {nt+un=Δn(nS(x,n,v,w)v),xΩ,t>0,vt+uv=Δvv+w,xΩ,t>0,wt+uw=Δww+n,xΩ,t>0,ut+κ(u)u+P=Δu+nϕ,xΩ,t>0,u=0,xΩ,t>0,(nnS(x,n,v,w)v)ν=vν=wν=0,u=0,xΩ,t>0,n(x,0)=n0(x),v(x,0)=v0(x),w(x,0)=w0(x),u(x,0)=u0(x),xΩ, (1.5)

    where ΩR2 is a bounded domain with smooth boundary, and S(x,n,v,w) satisfies

    SC2(ˉΩ×[0,)3;R2×2), (1.6)

    and

    |S(x,n,v,w)|CS(n+1)α,(x,n,v,w)Ω×[0,)3 (1.7)

    with some CS>0 and α0. To state our main results of this paper, we make the following assumptions that

    ϕW2,(Ω), (1.8)

    and the initial data (n0,v0,w0,u0) satisfies

    {n0Cι(ˉΩ) with n00 in Ω for certain ι>0,v0W1,(Ω) with v00 in ˉΩ,w0W1,(Ω) with w00 in ˉΩ,u0D(Aγr) for some γ(12,1) and any r(1,), (1.9)

    where Ar denotes the Stokes operator with domain D(Ar):=W2,r(Ω)W1,r0(Ω)Lrσ(Ω) and Lrσ(Ω):={φLr(Ω)|φ=0} [37].

    With these assumptions at hand, we can state the following main results.

    Theorem 1.1. If (1.6), (1.7), (1.8) and (1.9) hold, then for any

    α>0, (1.10)

    there exists a global classical solution (n,v,w,u,P) of problem (1.5) which fulfills

    {nC0(ˉΩ×[0,))C2,1(ˉΩ×(0,)),vC0(ˉΩ×[0,))C2,1(ˉΩ×(0,))L([0,);W1,p(Ω)),wC0(ˉΩ×[0,))C2,1(ˉΩ×(0,))L([0,);W1,q(Ω)),uC0(ˉΩ×[0,);R2)C2,1(ˉΩ×(0,);R2)L([0,);D(Aγ)),PC1,0(ˉΩ×(0,)) (1.11)

    with p,q>1 and γ(0,1), where n, v and w are nonnegative in Ω×(0,). Moreover, the solution is bounded, and there exists C(γ)>0 such that

    n(,t)L(Ω)+w(,t)W1,(Ω)+v(,t)W1,(Ω)+Aγu(,t)L2(Ω)C(γ) (1.12)

    for all t>0, where γ is given by (1.9).

    Remark 1.1. Theorem 1.1 improves the result of Yu [38], which showed that if α>0, then the Stokes version of problem (1.5) possesses a global classical solution.

    This paper is organized as follows. In Section 2, we claim that the regularized problem possesses at least one local classical solution which is nonnegative. Relying on a series of ε-independent a priori estimates obtained in Section 3, in Section 4 we verify the local existence of a classical solution for regularized problem can be extended to the global. In Section 5, we will construct a global weak solution which has enough regularity to become a classical solution to prove our main results.

    Compared with the classical Keller-Segel model, the convection term presenting in the Navier-Stokes equations engenders more mathematical difficulties. We define

    Sε(x,n,v,w):=ρε(x)χε(n)S(x,n,v,w) for all (x,n,v,w)ˉΩ×[0,)3, (2.1)

    where {ρε}ε(0,1)C0(Ω) is a family of standard cut-off functions fulfilling 0ρε1 in Ω and ρε1 in Ω as ε0, and χεC0([0,)) satisfies 0χε1 in [0,) and χε1 in [0,) as ε0.

    Then, we can introduce the following approximate system of (1.5):

    {nεt+uεnε=Δnε(nεSε(x,nε,vε,wε)vε),xΩ,t>0,vεt+uεvε=Δvεvε+wε,xΩ,t>0,wεt+uεwε=Δwεwε+nε,xΩ,t>0,uεt+Pε=Δuεκ(Yεuε)uε+nεϕ,xΩ,t>0,uε=0,xΩ,t>0,nεν=vεν=wεν=0,uε=0,xΩ,t>0,nε(x,0)=n0(x),vε(x,0)=v0(x),wε(x,0)=w0(x),uε(x,0)=u0(x),xΩ, (2.2)

    where

    Yεξ:=(1+εA)1ξ for all ξL2σ(Ω)

    is the standard Yosida approximation, and A:=PΔ is the realization of the Stokes operator with P denoting the Helmholtz projection of L2(Ω) onto solenoidal subspace L2σ(Ω) [37].

    Our main idea is to construct a weak solution which is globally bounded (the concept of weak solution can be found in Definition 5.1), and we claim it possesses adequate regularity to be a classical solution. The biggest obstacle we must deal with is the bad regularity of n caused by the small exponent α. Our main tool is based upon an energy estimate concerning the functional

    Ωn1+αε(,t)+Ω|vε(,t)|2,

    which successfully overcomes this difficulty. The appropriately regularized problem (2.2) possesses local-in-time classical solution, which can be stated as follows.

    Lemma 2.1. Suppose ϕW2,(Ω) and ε(0,1). Let ΩR2 be a bounded domain with smooth boundary. Then, there exist Tmax,ε(0,] and a classical solution (nε,vε,wε,uε,Pε) of (2.2) in Ω×(0,Tmax,ε) such that

    {nεC0(ˉΩ×[0,Tmax,ε))C2,1(ˉΩ×(0,Tmax,ε)),vεC0(ˉΩ×[0,Tmax,ε))C2,1(ˉΩ×(0,Tmax,ε)),wεC0(ˉΩ×[0,Tmax,ε))C2,1(ˉΩ×(0,Tmax,ε)),uεC0(ˉΩ×[0,Tmax,ε))C2,1(ˉΩ×(0,Tmax,ε)),PεC1,0(ˉΩ×(0,Tmax,ε)) (2.3)

    solves (2.2) in the classical sence in Ω×[0,Tmax,ε), and that nε, vε and wε are nonnegative in Ω×(0,Tmax,ε). Moreover, if Tmax,ε<, then we have

    nε(,t)L(Ω)+vε(,t)W1,(Ω)+wε(,t)W1,(Ω)+Aγuε(,t)L2(Ω)

    as tTmax,ε, where γ is similar to that in (1.9).

    Proof. The fixed point argument which is established in [39,40] enables us to immediately substantiate the local existence for a classical solution which complies with (2.3). That nε, vε and wε are nonnegative is a clear conclusion of the maximum principle [41].

    In this section, we will derive a series ε-independent a priori estimates of the classical solution (nε,vε,wε,uε) of regularized problem (2.2) from Lemma 2.1. By the way, we take τ=min{1,14Tmax,ε}. The positive constants Ci (iN) appearing in the proof of every lemma are independent of ε(0,1), which only depend on Ω,α,CS,ϕ,n0,v0,w0 and u0 if there is no especial explanation. Firstly, by simple integration and ODE comparison arguments, we obtain the following boundedness of L1-norms, which is common in many chemotaxis models.

    Lemma 3.1. For any ε(0,1), the solution of (2.2) satisfies

    Ωnε(,t)=Ωn0 for all t(0,Tmax,ε) (3.1)

    as well as

    Ωwε(,t)max{Ωn0,Ωw0} for all t(0,Tmax,ε) (3.2)

    and

    Ωvε(,t)max{Ωn0,Ωv0,Ωw0} for all t(0,Tmax,ε). (3.3)

    Lemma 3.2. If α>0, then for any μ>0, there exists a constant C>0 independent of ε(0,1) such that

    nε(,t)2L1+α(Ω)μnαε(,t)2L2(Ω)+C for all t(0,Tmax,ε). (3.4)

    Proof. For any μ>0, the Gagliardo-Nirenberg inequality and the Young inequality provide positive constants C1 and C2 such that

    nε2L1+α(Ω)=nαε2αLα+1αC1nαε21+αL2(Ω)nαε2α(1+α)L1α(Ω)+C1nαε2αL1α(Ω)μnαε2L2(Ω)+C2 for all t(0,Tmax,ε), (3.5)

    where the boundedness of nεL1(Ω) from (3.1) and the fact that 21+α<2 by α>0 are used.

    Lemma 3.3. If α>0 and p[2,2+2α1+α), then there exists some C>0 such that for all ε(0,1) the solution of (2.2) satisfies

    {Ωn2αε(,t)+Ωv2ε(,t)+Ωwpε(,t)C for all t(0,Tmax,ε) if α12Ωnε(,t)lnnε(,t)+Ωv2ε(,t)+Ωwpε(,t)C for all t(0,Tmax,ε) if α=12 (3.6)

    and

    t+τtΩ|nαε|2+t+τtΩ|vε|2+t+τtΩ|wp2ε|2C for all t(0,Tmax,ετ). (3.7)

    Proof. This proof may be divided into two cases:

    Case 1, α12.

    First, multiplying the first equation of (2.2) by n2α1ε, employing the fact that uε=0, integrating by parts, we derive

    12αddtΩn2αε+2α1α2Ω|nαε|2=Ωn2α1ε(nεSε(x,nε,vε,wε)vε). (3.8)

    Applying the Young inequality and the trivial fact nεnε+11, by (1.7), we obtain

    sgn(2α1)2αddtΩn2αε+|2α1|α2Ω|nαε|2=sgn(2α1)Ωn2α1ε(nεSε(x,nε,vε,wε)vε)|2α1|Ωn2α1ε|Sε(x,nε,vε,wε)||vε||nε||2α1|CSΩn2α1ε(nε+1)α|vε||nε||2α1|2α2Ω|nαε|2+|2α1|2C2SΩ|vε|2. (3.9)

    Namely,

    sgn(2α1)αddtΩn2αε+|2α1|α2Ω|nαε|2|2α1|C2SΩ|vε|2. (3.10)

    Next, testing the second equation of (2.2) by vε, utilizing the fact that uε is divergence-free and the continuous embedding W1,2(Ω)L1+αα(Ω), by virtue of the Hölder inequality and the Cauchy-Schwarz inequality, we deduce that there exists a constant C1>0 satisfying

    12ddtΩv2ε+Ω|vε|2+Ωv2ε=ΩvεwεvεL1+αα(Ω)wεL1+α(Ω)C1vεW1,2(Ω)wεL1+α(Ω)12Ωv2ε+12Ω|vε|2+12C21wε2L1+α(Ω). (3.11)

    Hence,

    ddtΩv2ε+Ω|vε|2+Ωv2εC21wε2L1+α(Ω). (3.12)

    This along with a multiple of (3.10) yields that

    ddt(sgn(2α1)2α|2α1|C2SΩn2αε+Ωv2ε)+12α2C2SΩ|nαε|2+12Ω|vε|2+Ωv2εC21wε2L1+α(Ω). (3.13)

    Then, multiplying the third equation of (2.2) by wp1ε with p[2,2+2α1+α), integrating by parts, applying the Hölder and the Cauchy-Schwarz inequalities as well as the fact uε=0, we have

    1pddtΩwpε+4(p1)p2Ω|wp2ε|2+Ωwpε=Ωnεwp1εnεL1+α(Ω)wp1εL1+αα(Ω)12nε2L1+α(Ω)+12wp1ε2L1+αα(Ω). (3.14)

    Combining (3.13) and (3.14), we get

    ddt(sgn(2α1)2α|2α1|C2SΩn2αε+Ωv2ε+1pΩwpε)+12α2C2SΩ|nαε|2+4(p1)p2Ω|wp2ε|2+12Ω|vε|2+Ωv2εC21wε2L1+α(Ω)+12nε2L1+α(Ω)+12wp1ε2L1+αα(Ω) for all t(0,Tmax,ε). (3.15)

    To handle these three terms on the right side of (3.15), one can employ the Gagliardo-Nirenberg and the Young inequalities as well as Lemma 3.2 to estimate

    C21wε2L1+α(Ω)=C21wp2ε4pL2(1+α)p(Ω)C2wp2ε4α(1+α)pL2(Ω)wp2ε4(1+α)pL2p(Ω)+C2wp2ε4pL2p(Ω)p1p2wp2ε2L2(Ω)+C3 (3.16)

    as well as

    12wp1ε2L1+αα=12wp2ε4(p1)pL2(p1)(1+α)pα(Ω)C4wp2ε4p(p1α1+α)L2(Ω)wp2ε4αp(1+α)L2p(Ω)+C4wp2ε4(p1)pL2p(Ω)p1p2wp2ε2L2(Ω)+C5 (3.17)

    and

    12nε2L1+α(Ω)14α2C2SΩ|nαε|2+C6 (3.18)

    with positive constants C2, C3, C4, C5 and C6, where we have 4α(1+α)p<2 and 4p(p1α1+α)<2 by p[2,2+2α1+α). Substituting (3.16), (3.17) and (3.18) into (3.15), one has

    ddt(sgn(2α1)2α|2α1|C2SΩn2αε+Ωv2ε+1pΩwpε)+14α2C2SΩ|nαε|2+2(p1)p2Ω|wp2ε|2+12Ω|vε|2+Ωv2εC7 for all t(0,Tmax,ε) (3.19)

    with C7:=C3+C5+C6. If sgn(2α1)=1 (i.e. α>12), (3.19) in conjunction with some standard arguments implies that (3.6) and (3.7) hold. On the other hand, if sgn(2α1)=1 (i.e. 0<α<12), we set

    fε(t):=12α|2α1|C2SΩn2αε(,t)+Ωv2ε(,t)+1pΩwpε(,t) (3.20)

    and

    gε(t):=14α2C2SΩ|nαε(,t)|2+12Ω|vε(,t)|2+p1p2Ω|wp2ε(,t)|2. (3.21)

    By the Gagliardo-Nirenberg estimate

    1pΩwpε=1pwp2ε2L2(Ω)C8wp2ε22pL2(Ω)wp2ε2pL2p(Ω)+C8wp2ε2L2p(Ω)p1p2Ω|wp2ε|2+C9

    and (3.19), we deduce

    ddtfε(t)+fε(t)+gε(t)C10 for all t(0,Tmax,ε) (3.22)

    with C10:=C7+C9, where we observe the fact that fε(t)Ωv2ε(,t)+1pΩwpε(,t). In view of an ODE comparison argument, from (3.22), we obtain a constant C11>0 such that

    12α|2α1|C2SΩn2αε+Ωv2ε+1pΩwpεC11. (3.23)

    Since 0<α<12, the boundedness of Ωn2αε is an immediate consequence by (3.1). Thus, (3.23) guarantees the existence of some constant C12>0 satisfying

    Ωv2ε+1pΩwpε12α|2α1|C2SΩn2αε+C11C12 for all t(0,Tmax,ε). (3.24)

    Integrating (3.19) in time, there exists a C13>0 fulfilling

    t+τtΩ|nαε|2+t+τtΩ|vε|2+t+τtΩ|wp2ε|2C13 for all t(0,Tmax,ετ). (3.25)

    Consequently, (3.6) and (3.7) hold for α12.

    Case 2, α=12.

    By the first equation of (2.2), one may exploit the Young inequality to estimate

    ddtΩnεlnnε=Ωnεtlnnε+Ωnεt=ΩΔnεlnnεΩlnnε(nεSε(x,nε,vε,wε)vε)Ω|nε|2nε+CSΩ(nε+1)12|nε||vε|12Ω|nε|2nε+12C2SΩ|vε|2. (3.26)

    That is,

    ddtΩnεlnnε+12Ω|nε|2nε12C2SΩ|vε|2. (3.27)

    Using the same arguments as proving case 0<α<12, it is deduced that

    Ωnεlnnε+Ωv2ε+ΩwpεC14 for all t(0,Tmax,ε), (3.28)

    and

    t+τtΩ|nε|2nε+t+τtΩ|vε|2+t+τtΩ|wp2ε|2C15 for all t(0,Tmax,ετ) (3.29)

    with positive constants C14 and C15. Thus, (3.6) and (3.7) hold for α=12.

    Therefore, we may merge these two cases to conclude that (3.6) and (3.7) hold for any α>0. We complete this proof.

    Lemma 3.4. There exists a constant C>0 independent of ε(0,1) such that the solution of (2.2) satisfies

    Ω|uε|2(,t)C for all t(0,Tmax,ε) (3.30)

    and

    t+τtΩ|uε|2C for all t(0,Tmax,ετ). (3.31)

    Proof. Multiplying the fourth equation of (2.2) by uε, recalling the fact that uε is divergence-free, integrating by parts, we have

    12ddtΩ|uε|2+Ω|uε|2=Ωnεuεϕ for all t(0,Tmax,ε). (3.32)

    Then, in light of the Hölder inequality as well as the Young inequality and the continuous embedding W1,2(Ω)L1+αα(Ω), we apply Lemma 3.2 to estimate

    ΩnεuεϕnεL1+α(Ω)uεL1+αα(Ω)ϕL(Ω)C1nεL1+α(Ω)uεL2(Ω)ϕL(Ω)12uε2L2(Ω)+C2nε2L1+α(Ω)12uε2L2(Ω)+nαε2L2(Ω)+C3 (3.33)

    with positive constants C1, C2 and C3. Now, inserting (3.33) into (3.32) and considering the estimate obtained by (3.7), we obtain

    Ω|uε|2C4 for all t(0,Tmax,ε) (3.34)

    and

    t+τtΩ|uε|2C5 for all t(0,Tmax,ετ) (3.35)

    with positive constants C4 and C5. The proof is completed.

    By almost exactly analogous argument with Lemma 6.1 in [29], one can directly derive the higher norm estimate of wε.

    Lemma 3.5. For any q2, one can find a constant C>0 independent of ε(0,1) such that

    wε(,t)Lq(Ω)C for all t(0,Tmax,ε). (3.36)

    Lemma 3.6. For any ε(0,1), there exists a constant C>0 that satisfies

    Ω|vε(,t)|2C for all t(0,Tmax,ε) (3.37)

    and

    t+τtΩ|Δvε|2C for all t(0,Tmax,ετ). (3.38)

    Proof. Testing the second equation in (2.2) by Δvε, by applying the Young inequality and integrating by parts, we derive

    12ddtΩ|vε|2+Ω|Δvε|2+Ω|vε|2=ΩwεΔvε+Ω(uεvε)Δvε14Ω|Δvε|2+Ωw2εΩvε(uεvε)14Ω|Δvε|2Ωvε(uεvε)+C1, (3.39)

    where the positive constant C1 satisfies Ωw2εC1, and we have the fact that

    Ωvε(D2vεuε)=12Ωuε|vε|2=0. (3.40)

    In view of the standard elliptic regularity theory, the Gagliardo-Nirenberg inequality and the Young inequality provide a constant C2>0 fulfilling

    Ωvε(uεvε)uεL2(Ω)vε2L4(Ω)C2uεL2(Ω)vεL2(Ω)ΔvεL2(Ω)C22uε2L2(Ω)vε2L2(Ω)+14Δvε2L2(Ω). (3.41)

    This in conjunction with (3.39) indicates that

    12ddtΩ|vε|2+12Ω|Δvε|2+Ω|vε|2C22uε2L2(Ω)vε2L2(Ω)+C1 for all t(0,Tmax,ε). (3.42)

    If we put

    yε(t):=12Ω|vε(,t)|2

    and

    ρε(t):=2C22Ω|uε(,t)|2,

    then (3.42) yields that

    ddtyε(t)+zε(t)ρε(t)yε(t)+C1 for all t(0,Tmax,ε), (3.43)

    where

    zε(t)=12Ω|Δvε(,t)|2.

    Recalling the estimates inferred from (3.7) and (3.31), there are two positive constants C3 and C4 satisfying

    t+τtyε(s)dsC3 for all t(0,Tmax,ετ)

    and

    t+τtρε(s)dsC4 for all t(0,Tmax,ετ).

    Furthermore, for any t(0,Tmax,ε), one can pick a t0[(tτ)+,t) such that yε(,t0)C5 with some C5>0. Invoking the Gronwall inequality, we obtain

    yε(t)yε(t0)ett0ρε(s)ds+tt0etsρε(τ)dτC1dsC5eC4+tt0eC4C1dsC5eC4+C1eC4 for all t(0,Tmax,ε), (3.44)

    which implies (3.37). Finally, integrating (3.42) in time and exploiting the estimates obtained in (3.37) and (3.31), we can verify (3.38) is valid.

    Lemma 3.7. If α>0, then there exists a constant C>0 independent of ε(0,1) such that

    Ωn1+αε(,t)C for all t(0,Tmax,ε) (3.45)

    and

    t+τtΩnα1ε|nε|2C for all t(0,Tmax,ετ). (3.46)

    Particularly, one has

    t+τtΩn2εC for all t(0,Tmax,ετ). (3.47)

    Proof. Testing the first equation of (2.2) by nαε, noticing the fact that uε=0 and integrating by parts, by using the Young inequality and (1.7), we arrive at

    11+αddtnε1+αL1+α(Ω)+αΩnα1ε|nε|2=Ωnαε(nεSε(x,nε,vε,wε)vε)αCSΩnαε(nε+1)α|nεvε|α4Ωnα1ε|nε|2+αC2SΩn1+αε(nε+1)2α|vε|2α4Ωnα1ε|nε|2+αC2S2Ωn2ε+αC2S2Ωn2αε(nε+1)4α|vε|4α4Ωnα1ε|nε|2+αC2S2Ωn2ε+αC2S2Ω|vε|4, (3.48)

    where one can readily see that n2αε(nε+1)4α=(nεnε+1)2α(nε+1)2α<1 by α>0. By means of the Gagliardo-Nirenberg inequality and the Young inequality, we conclude that

    αC2S2Ωn2ε=αC2S2n1+α2ε41+αL41+α(Ω)C1nε1+α221+αL2(Ω)n1+α2ε21+αL21+α(Ω)+C1n1+α2ε41+αL21+α(Ω)α4Ωnα1ε|nε|2+C2 (3.49)

    with positive constants C1 and C2, where we observe the truth that 21+α<2 by α>0. Moreover, looking back on the estimate in (3.37), we utilize the Gagliardo-Nirenberg inequality and the elliptic regularity to ensure the existence of constants C3>0 and C4>0 such that

    αC2S2Ω|vε|4=αC2S2vε4L4(Ω)C3Δvε2L2(Ω)vε2L2(Ω)C4Δvε2L2(Ω). (3.50)

    Accordingly, (3.48) in combination with (3.49) and (3.50) leads to

    11+αddtnε1+αL1+α(Ω)+α2Ωnα1ε|nε|2C4Ω|Δvε|2+C2 for all t(0,Tmax,ε). (3.51)

    Recalling the spatio-temporal boundedness of t+τtΩ|Δvε|2 inferred from (3.38), (3.51) implies (3.45) and (3.46). Finally, integrating (3.49) in time, (3.46) yields (3.47).

    Relying on the spatio-temporal estimates of t+τtΩ|uε|2 (see Lemma 3.4) and t+τtΩn2ε (see Lemma 3.7), one can improve the regularity features of the corresponding fluid field. Since the proof may be found in many papers [42], the details are omitted in order to avoid duplication.

    Lemma 3.8. There exists some C>0 such that for all ε(0,1) the solution of (2.2) satisfies

    Ω|uε(,t)|2C for all t(0,Tmax,ε). (3.52)

    In this section, we will prove the local-in-time solutions of regularized problem (2.2) are actually global. Without loss of generality, in this section we presume 0<α<12. If α12, at least the boundedness of nεL32(Ω) can be deduced from (3.45). With the higher regularity of nε, it becomes easier than case 0<α<12 to get our desired conclusion. Thanks to the well-known smoothing properties of the Stokes semigroup and the Neumann heat semigroup, one can derive the following uniform L estimates for nε, vε, wε and uε.

    Lemma 4.1. If α>0 and γ(12,1), then there exists a constant C>0 such that for all ε(0,1), the classical solution of (2.2) satisfies

    nε(,t)L(Ω)+vε(,t)W1,(Ω)+wε(,t)W1,(Ω)+uε(,t)L(Ω)+Aγuε(,t)L2(Ω)C for all t(0,Tmax,ε). (4.1)

    Moreover, for p>1, we can find a positive constant C(p) such that

    uε(,t)Lp(Ω)C(p) for all t(0,Tmax,ε). (4.2)

    Proof. For the sake of clarity, this proof is divided into several steps. It is worth mentioning that the following constants Ci (iN) are independent of ε(0,1).

    Step 1. The boundedness of wε(,t)L21α(Ω) and vε(,t)L˜p(Ω) with ˜p>2 for all t(0,Tmax,ε).

    Since 0<α<12, we have 21α>2. First, utilizing the variation-of-constants formula for wε, we obtain

    wε(,t)L21α(Ω)et(Δ+1)w0L21α(Ω)+t0e(ts)(Δ+1)nε(,s)L21α(Ω)ds+t0e(ts)(Δ+1)(uε(,s)wε(,s))L21α(Ω)ds. (4.3)

    With the boundedness of nε(,s)L1+α(Ω) obtained by Lemma 3.7, in view of the LpLq estimates associated heat semigroup, we deduce

    et(Δ+1)w0L21α(Ω)C11 for all t(0,Tmax,ε) (4.4)

    and

    t0e(ts)(Δ+1)nε(,s)L21α(Ω)dsC1t0[(ts)12(11+α1α2)+1]eλ(ts)nε(,s)L1+α(Ω)dsC2 for all t(0,Tmax,ε) (4.5)

    with λ>0, where we have the fact that 12(11+α1α2)>1 by 0<α<12. Furthermore, taking ς=1940 and δ=180 so that 12+(151α2)<ς and ς12δ>1, we can infer that

    t0e(ts)(Δ+1)(wε(,s)uε(,s))L21α(Ω)dsC3t0(Δ+1)ςe(ts)(Δ+1)(wε(,s)uε(,s))L5(Ω)dsC4t0(ts)ς12δeμ(ts)wε(,s)uε(,s)L5(Ω)dsC5t0(ts)ς12δeμ(ts)wε(,s)L10(Ω)uε(,s)L10(Ω)dsC6 for all t(0,Tmax,ε), (4.6)

    where the boundedness of uε(,s)L10(Ω) is derived from Lemma 3.8 along with the continuous embedding W1,2(Ω)L10(Ω), and wε(,s)L10(Ω) is ensured by Lemma 3.5. Therefore, by accumulating (4.3)-(4.6), the boundedness of wε(,t)L21α(Ω) is obtained. With some very similar arguments, one can derive the boundedness of vε(,t)L˜p(Ω) with some ˜p>2.

    Step 2. The boundedness of nε(,t)L(Ω) for all t(0,Tmax,ε).

    Letting

    M(T):=supt(0,T)nε(,t)L(Ω)

    and

    ˜hε:=Sε(x,nε,vε,vε)vε+uε,

    then by the L˜p estimate of vε, we obtain

    ˜hε(,t)L˜p(Ω)C7 for all t(0,Tmax,ε). (4.7)

    Exploiting the associate variation-of-constants formula for nε, in light of the fact that uε=0, we obtain

    nε(,t)=e(tt0)Δnε(,t0)tt0e(ts)Δ(nε(,s)˜hε(,s))ds for t(t0,T) with t0:=(t1)+. (4.8)

    If 0<t1, then in view of the maximum principle, we have

    e(tt0)Δnε(,t0)L(Ω)n0L(Ω). (4.9)

    If t>1, then by the LpLq estimates of the Neumann heat semigroup, we deduce

    e(tt0)Δnε(,t0)L(Ω)C8(tt0)22nε(,t0)L1(Ω)C9. (4.10)

    Next, fixing q(2,˜p), we may utilize the well-known smoothing properties of the Neumann heat semigroup and the Hölder inequality to conclude

    tt0e(ts)Δ(nε(,s)˜hε(,s))L(Ω)dsC10tt0(ts)1222qnε(,s)˜hε(,s)Lq(Ω)dsC10tt0(ts)1222qnε(,s)Lq˜p˜pq(Ω)˜hε(,s)L˜p(Ω)dsC10tt0(ts)1222qnε(,s)σL(Ω)nε(,s)1σL1(Ω)˜hε(,s)L˜p(Ω)dsC11Mσ(T) for all t(0,T), (4.11)

    where σ:=q˜p˜p+qq˜p(0,1), and 1222q>1 by q>2. Collecting (4.7)–(4.11) and utilizing the definition of M(T), there is a C12>0 such that

    M(T)C12+C12Mσ(T) for all T(0,Tmax,ε).

    Since σ<1, by some basic calculation we have

    nε(,t)L(Ω)C13 for all t(0,Tmax,ε).

    Step 3. The boundedness of uε(,t)L(Ω) and Aγuε(,t)L2(Ω) for all t(0,Tmax,ε).

    Employing the Helmholtz projection P to the fourth equation in (2.2), we get the variation-of-constants formula of uε

    uε(,t)=etAu0+t0e(ts)Ahε(,s)ds for all t(0,Tmax,ε),

    where hε(,s)=P[nε(,s)ϕκ(Yεuε(,s))uε(,s)]. With the standard smoothing properties of the Stokes semigroup, we derive that for all t(0,Tmax,ε) and any γ(12,1), there exist C14>0 and C15>0 fulfilling

    Aγuε(,t)L2(Ω)Aγu0L2(Ω)+t0Aγe(ts)Ahε(,s)L2(Ω)dsC14+C15t0(ts)γ(1p012)eλ(ts)hε(,s)Lp0(Ω)ds. (4.12)

    Choosing p0(232γ,2) such that

    γ(1p012)>1, (4.13)

    the L-estimate of nε provides a C16>0 fulfilling

    nε(,t)Lp0(Ω)C16 for all t(0,Tmax,ε).

    Next, considering the embedding W1,2(Ω)L2p02p0(Ω) and the boundedness of uε(,t)L2(Ω) (see Lemma 3.8), we employ the Hölder inequality and the fact that P is continuous in Lp(Ω;R2) to achieve that

    hε(,t)Lp0(Ω)C17(Yεuε(,t))uε(,t)Lp0(Ω)+C17nε(,t)Lp0(Ω)C17Yεuε(,t)L2p02p0(Ω)uε(,t)L2(Ω)+C18C19Yεuε(,t)L2(Ω)uε(,t)L2(Ω)+C18C20 for all t(0,Tmax,ε), (4.14)

    where we notice the fact that

    YεuεL2(Ω)=A12YεuεL2(Ω)=YεA12uεL2(Ω)A12uεL2(Ω)=uεL2(Ω).

    Assembling (4.12), (4.13) and (4.14), we conclude that

    Aγuε(,t)L2(Ω)C21+C21t0(ts)γ(1p012)eλ(ts)hε(,s)Lp0(Ω)dsC22 for all t(0,Tmax,ε), (4.15)

    which in combination with the continuous embedding D(Aγ)L(Ω) by γ(12,1) yields that

    uε(,t)L(Ω)C23 for all t(0,Tmax,ε). (4.16)

    Step 4. The boundedness of uε(,t)Lp(Ω) with p>1 for all t(0,Tmax,ε).

    For any p>1, we can pick suitable γ(12,1) satisfying γ>11p. By means of the embedding D(Aγ)W1,p(Ω;R2) (see [37]), (4.2) holds.

    Step 5. The boundedness of wε(,t)W1,(Ω) and vε(,t)W1,(Ω) for all t(0,Tmax,ε).

    Fixing θ(12+1α2,1), the domain of the fractional power D((Δ+1)θ) can be embedded into W1,(Ω) [4]. Accordingly, exploiting the LpLq estimates associated heat semigroup, one has

    wε(,t)W1,(Ω)C24(Δ+1)θwε(,t)L21α(Ω)C25tθeμtw0L21α(Ω)+C25t0(ts)θeμ(ts)(nεuεwε)(,s)L21α(Ω)dsC26+C26t0(ts)θeμ(ts)[nε(,s)L21α(Ω)+uε(,s)L(Ω)wε(,s)L21α(Ω)]dsC27 for all t(τ0,Tmax,ε)

    with τ0(0,Tmax,ε). An application of the local solvability of (2.2) indicates that for some C28>0,

    wε(,t)W1,(Ω)C28 for all t(0,Tmax,ε). (4.17)

    Meanwhile, a similar argument yields a C29>0 satisfying

    vε(,t)W1,(Ω)C29 for all t(0,Tmax,ε). (4.18)

    The proof is completed. With the uniform L bounds of nε, vε, wε and uε at hand, we claim that the local classical solution of regularized problem (2.2) which is constructed in Lemma 2.1 can be extended to the global.

    Proposition 4.1. Let α>0, γ(12,1). Let (nε,vε,wε,uε,Pε)ε(0,1) be classical solutions of (2.2) constructed in Lemma 2.1 on [0,Tmax,ε). Then, we have Tmax,ε=. Moreover, one can find a C>0 which is independent of ε(0,1) such that

    nε(,t)L(Ω)+vε(,t)W1,(Ω)+wε(,t)W1,(Ω)+uε(,t)L(Ω)+Aγuε(,t)L2(Ω)C for all t(0,). (4.19)

    In addition, there is a C(p)>0 fulfilling

    uε(,t)Lp(Ω)C(p) for all t(0,). (4.20)

    As the straightforward result of Proposition 4.1, in light of the standard parabolic regularity (see e.g. Lemmata 3.18 and 3.19 in [43]), we can get the following Hölder continuity of vε,vε as well as wε,wε and uε.

    Lemma 4.2. If α>0, then there exist μ(0,1) and some C>0 such that

    vε(,t)Cμ,μ2(Ω×[t,t+1])+wε(,t)Cμ,μ2(Ω×[t,t+1])+uε(,t)Cμ,μ2(Ω×[t,t+1])C for all t(0,). (4.21)

    Moreover, for any τ>0, one can find a C(τ)>0 satisfying

    vε(,t)Cμ,μ2(Ω×[t,t+1])+wε(,t)Cμ,μ2(Ω×[t,t+1])C(τ) for all t(τ,). (4.22)

    With all the results established above, we are adequately prepared for proving Theorem 1.1. First, we state the concept of global weak solution.

    Definition 5.1. Let (n0,v0,w0,u0) satisfy (1.9) and T(0,]. Then, a fourfold of functions (n,v,w,u) which fulfills

    {nL1loc(ˉΩ×[0,T)),vL1loc([0,T);W1,1(Ω)),wL1loc([0,T);W1,1(Ω)),uL1loc([0,T);W1,1(Ω)), (5.1)

    and n as well as v and w are nonnegative in Ω×(0,T) and u is divergence-free in Ω×(0,T), and

    uuL1loc(ˉΩ×[0,);R2×2) and nL1loc(ˉΩ×[0,)),vu,wu,nu and nS(x,n,v,w)vL1loc(ˉΩ×[0,);R2) (5.2)

    is called a weak solution of problem (1.5) if the following integral identities are satisfied:

    T0ΩnφtΩn0φ(,0)=T0Ωnφ+T0ΩnS(x,n,v,w)vφ+T0Ωnuφ (5.3)

    for any φC0(ˉΩ×[0,T)) satisfying φν=0 on Ω×(0,T) and

    T0ΩvφtΩv0φ(,0)=T0ΩvφT0Ωvφ+T0Ωwφ+T0Ωvuφ (5.4)

    as well as

    T0ΩwφtΩw0φ(,0)=T0ΩwφT0Ωwφ+T0Ωnφ+T0Ωwuφ (5.5)

    for any φC0(ˉΩ×[0,T)) and

    T0ΩuφtΩu0φ(,0)=κT0ΩuuφT0ΩuφT0Ωnϕφ (5.6)

    for any φC0(ˉΩ×[0,T);R2) which is divergence-free in Ω×(0,T). If Ω×(0,)R5 is a weak solution of (1.5) in Ω×(0,T) for all T>0, then (n,v,w,u) is called a global weak solution of (1.5).

    In the following auxiliary outcome, we will derive the regularity property of time derivative so as to invoke the Aubin-Lions compactness lemma, which plays a prominent role in proving Theorem 1.1.

    Lemma 5.1. If α>0, then for any T>0 and all ε(0,1), there exists C(T)>0 such that

    T0Ω|nε|2C(T) (5.7)

    and

    T0tnε(,t)(W1,20(Ω))dtC(T). (5.8)

    Proof. Firstly, in view of Proposition 4.1, there exists a C1>0 such that

    nεC1,|vε|C1 and |uε|C1 in Ω×(0,). (5.9)

    Then, testing the first equation in (2.2) by nε, by virtue of (5.9), we have

    12ddtnε2L2(Ω)+Ω|nε|2=Ωnε(nεSε(x,nε,vε,wε)vε)CSΩnε|nε||vε|12Ω|nε|2+12C2SC41|Ω|. (5.10)

    Integrating (5.10) over (0,T), (5.7) is valid. Testing the first equation in (2.2) by φC0(Ω), we conclude there is a ˜C:=C(C1,Ω,CS)>0 such that

    Ωnεt(,t)φ=Ω[Δnε(nεSε(x,nε,vε,wε)vε)uεnε]φ=Ωnεφ+ΩnεSε(x,nε,vε,wε)vεφ+Ωnεuεφ˜C(nεL2(Ω)+vεL2(Ω))φW1,20(Ω). (5.11)

    Therefore, by the definition of the operator norm, one has

    nεt(,t)2(W1,20(Ω))˜C(nε2L2(Ω)+vε2L2(Ω)). (5.12)

    Recalling the estimates obtained in (5.7) and (3.37), integrating (5.12) in time, we finally get (5.8).

    As an application of the parabolic regularity theory, we may further derive the following Hölder continuity of nε.

    Lemma 5.2. For any ε(0,1), there exist a positive constant C and θ(0,1) such that

    nε(,t)Cθ,θ2(ˉΩ×[t,t+1])C for all t(0,). (5.13)

    Proof. Firstly, the first equation of (2.2) can be rewritten as the following sub-problem:

    {nεt=a(x,t,nε)+b(x,t,nε),xΩ,t>0,a(x,t,nε)ν=0,xΩ,t>0,nε(x,0)=n0(x),xΩ, (5.14)

    where a(x,t,ξ):=ξnεSε(x,nε,vε,wε)vε and b(x,t,ξ):=uεξ with (x,t,ξ)Ω×(0,)×R2. By means of the Young inequality and basic analysis as well as Proposition 4.1, we obtain

    ξa(x,t,ξ)=|ξ|2nεSε(x,nε,vε,wε)vεξ12|ξ|2C1|vε|2,(x,t,ξ)Ω×(0,)×R2 (5.15)

    and

    |a(x,t,ξ)|C2|vε|+|ξ|,(x,t,ξ)Ω×(0,)×R2 (5.16)

    as well as

    |b(x,t,ξ)|12|ξ|2+C3,(x,t,ξ)Ω×(0,)×R2 (5.17)

    with positive constants C1, C2 and C3. Moreover, Proposition 4.1 points out that |vε| and |vε|2 belong to L((0,);Lp(Ω)) for any p>1. In light of the parabolic regularity theory [44], for any τ>0, there exist θ:=θ(τ)(0,1) and some constant C(τ)>0 such that

    nε(,t)Cθ,θ2(ˉΩ×[t,t+1])C(τ) for all tτ, (5.18)

    which completes the proof. According to classical Schauder estimates, we may exploit the same arguments with Lemmata 9.1, 9.2 and 9.3 in [29] to derive the Hölder estimates in C2+θ,1+θ2 for vε, wε and uε, so we leave out the details.

    Lemma 5.3. If α>0, then for τ>0, there exist θ(0,1) and C(τ)>0 such that the solution of (2.2) satisfies

    uε(,t)C2+θ,1+θ2(ˉΩ×[t,t+1])+vε(,t)C2+θ,1+θ2(ˉΩ×[t,t+1])+wε(,t)C2+θ,1+θ2(ˉΩ×[t,t+1])C(τ) for all tτ. (5.19)

    Based on above preparations, Theorem 1.1 may be proved by utilizing some standard compactness arguments and the parabolic regularity theory.

    Lemma 5.4. If α>0, then there exist θ(0,1),{εj}jN(0,1) and functions

    {nCθ,θ2loc(ˉΩ×[0,))C2+θ,1+θ2loc(ˉΩ×(0,)),vCθ,θ2loc(ˉΩ×[0,))C2+θ,1+θ2loc(ˉΩ×(0,)),wCθ,θ2loc(ˉΩ×[0,))C2+θ,1+θ2 loc (ˉΩ×(0,)),uCθ,θ2loc(ˉΩ×[0,);R2)C2+θ,1+θ2loc(ˉΩ×(0,);R2),PC1,0(ˉΩ×(0,)) (5.20)

    such that n, v and w are nonnegative in Ω×(0,T), and that

    {nεnC0 loc (ˉΩ×[0,)),vεvC0 loc (ˉΩ×[0,)),wεwC0 loc (ˉΩ×[0,)),uεuC0 loc (ˉΩ×[0,);R2) (5.21)

    as ε=εj0, and (n,v,w,u,P) solves (1.5) classically in Ω×(0,).

    Proof. By virtue of Proposition 4.1, Lemmata 4.2 and 5.1 and the Arzelà-Ascoli theorem, we can find a sequence ε=εj0 as j such that

    nεn weakly star in L(Ω×(0,)), (5.22)
    nεn weakly in L2loc(ˉΩ×[0,)), (5.23)
    vεv in C0loc(ˉΩ×[0,)), (5.24)
    vεv in C0loc(ˉΩ×(0,)), (5.25)
    vεv weakly star in L(Ω×(0,)), (5.26)
    wεw in C0loc(ˉΩ×[0,)), (5.27)
    wεw in C0loc(ˉΩ×(0,)), (5.28)
    wεw weakly star in L(Ω×(0,)) (5.29)

    as well as

    uεu in C0loc(ˉΩ×[0,)), (5.30)

    and

    DuεDu weakly star in L(Ω×(0,)) (5.31)

    hold with some limit functions n,v,w and u.

    By Lemma 5.1, we assert that nε belongs to L2((0,T);W1,2(Ω)), and tnε is bounded in L1((0,T);(W1,20(Ω))) for any T>0. Noticing the embedding W1,2(Ω)↪↪L2(Ω)(W1,20(Ω)), the Aubin-Lions lemma ([45]) along with some standard arguments allows us to derive

    nεn a.e. in Ω×(0,). (5.32)

    Now, we may verify the limit functions n, v, w and u exactly comply with the properties of a weak solution which are stated by Definition 5.1. The integrability conditions in (5.1) and (???) and the nonnegativity of n, v and w are evident by (5.22), (5.23), (5.24), (5.26), (5.27), (5.29), (5.30) and (5.32). Applying the dominated convergence theorem and some standard arguments to the corresponding weak formulations in the regularized problem (2.2) as ε=εj0, one can derive the integral identities (5.3)–(5.6) by using (5.22)–(5.32). Moreover, we have

    nεSε(x,nε,vε,wε)vεnS(x,n,v,w)v a.e. in Ω×(0,). (5.33)

    Thus, (n,v,w,u) becomes a global weak solution which exactly enjoys the conditions in Definition 5.1.

    Lastly, we claim that this weak solution is virtually a solution in the classical sense. Our method is strongly inspired by Lemma 4.3 in [46]. By means of Lemmata 5.2 and 5.3, we obtain

    {nεnCθ1,θ12loc(ˉΩ×[0,)),vεvCθ1,θ12loc(ˉΩ×[0,))C2+θ1,1+θ12loc(ˉΩ×(0,)),wεwCθ1,θ12loc(ˉΩ×[0,))C2+θ1,1+θ12loc(ˉΩ×(0,)),uεuCθ1,θ12loc(ˉΩ×[0,);R2)C2+θ1,1+θ12loc(ˉΩ×(0,);R2) (5.34)

    with some θ1(0,1) and subsequence ε=εj. In view of (5.7) and the Hölder regularities provided by (5.34), n possesses the needed regularity properties of a well-established result concerning the gradient Hölder continuity [47], which entails

    nC1+θ2,1+θ22loc(ˉΩ×(0,)) for some θ2(0,1). (5.35)

    Now, we consider the sub-problem ntΔn=g(x,t) with boundary condition nν=h(x,t)ν, where g:=(nu+nS(x,n,v,w)v) and h:=nS(x,n,v,w)v. As the desired Hölder estimates

    g(x,t)Cα1,α12loc(ˉΩ×(0,))unCα1,α12loc(ˉΩ×(0,))+nS(x,n,v,w)vCα1,α12loc(ˉΩ×(0,))C1 for some α1(0,1) (5.36)

    and

    h(x,t)C1+α2,1+α22loc(ˉΩ×(0,))=nS(x,n,v,w)vC1+α2,1+α22loc(ˉΩ×(0,))C2 for some α2(0,1) (5.37)

    are warranted by (5.34) and (5.35), invoking the standard parabolic regularity theory [48], we can find a θ3(0,1) such that

    nC2+θ3,1+θ32loc(ˉΩ×(0,)). (5.38)

    This in combination with (5.34) yields a θ4(0,1) such that

    {nCθ4,θ42loc(ˉΩ×[0,))C2+θ4,1+θ42loc(ˉΩ×(0,)),vCθ4,θ42loc(ˉΩ×[0,))C2+θ4,1+θ42loc(ˉΩ×(0,)),wCθ4,θ42loc(ˉΩ×[0,))C2+θ4,1+θ42loc(ˉΩ×(0,)),uCθ4,θ42loc(ˉΩ×[0,);R2)C2+θ4,1+θ42loc(ˉΩ×(0,);R2), (5.39)

    which guarantees the sufficient Hölder regularity of (n,v,w,u) to be a solution in the classical sense and thereby completes the proof.

    Finally, Theorem 1.1 is immediate.

    Proof of Theorem 1.1. The statement follows from Lemma 5.4 in conjunction with Proposition 4.1.

    The author would like to express his sincere thanks to anonymous reviewers for their careful reading and constructive suggestions which largely improved this work.

    The author declares there is no conflict of interest.


    Acknowledgments



    This publication was made possible by Grant Number K01HP33459-02-01 from the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Health Resources and Services Administration or the U.S. Department of Health and Human Services.
    The authors thank Dr. Cleverick Johnson for his support and mentorship in implementing the project and providing the radiographs, Dr. Julian N. Holland III for his statistical support, Dr. Richard Halpin for his support in Qualtrics survey, and Dr. Sarah Toombs Smith for her editing service.

    Statement of ethical approval



    The studies involving human participants were reviewed and approved by IRB (#HSC-DB-16-1021) of the University of Texas Health Science Center at Houston. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Participant's information was completely confidential and only served for study purpose. Also, participants' involvement was voluntary without any incentives.

    Conflict of interest



    The authors declare no conflict of interests.

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