A robust adaptive algebraic multigrid linear solver for structural mechanics

The numerical simulation of structural mechanics applications via finite elements usually requires the solution of large-size and ill-conditioned linear systems, especially when accurate results are sought for derived variables interpolated with lower order functions, like stress or deformation fields. Such task represents the most time-consuming kernel in commercial simulators; thus, it is of significant interest the development of robust and efficient linear solvers for such applications. In this context, direct solvers, which are based on LU factorization techniques, are often used due to their robustness and easy setup; however, they can reach only superlinear complexity, in the best case, thus, have limited applicability depending on the problem size. On the other hand, iterative solvers based on algebraic multigrid (AMG) preconditioners can reach up to linear complexity for sufficiently regular problems but do not always converge and require more knowledge from the user for an efficient setup. In this work, we present an adaptive AMG method specifically designed to improve its usability and efficiency in the solution of structural problems. We show numerical results for several practical applications with millions of unknowns and compare our method with two state-of-the-art linear solvers proving its efficiency and robustness.Comment: 50 pages, 16 figures, submitted to CMAM

Absence bilatérale de foramen mentonnier: mythe ou réalité ?

Le nerf mentonnier, entièrement sensitif, est une branche terminale du nerf alvéolaire inférieur émergeant bilatéralement en regard de l apex de la deuxième prémolaire mandibulaire à travers le foramen mentonnier. De nombreuses variations anatomiques concernant ce foramen ont été décrites dans la littérature, telles que des localisations inhabituelles ou la présence de foramina multiples. Cependant, les cas d absences de foramen mentonnier sont plus rares et très souvent découverts lors de dissections post-mortem. Une possible perte de neurosensibilité dans la région labio-mentonnière est alors évoquée. Le cas clinique étudié ici concerne la découverte fortuite d une absence bilatérale de foramen mentonnier sur les examens radiographiques (CBCT) d un patient. Des tests de vitalité et de sensibilité ont permis d objectiver une absence de troubles neurosensoriels de la région concernée. Parmi les hypothèses avancées, la plus probable paraît être celle d une suppléance nerveuse par le plexus cervical superficiel dont des ramifications peuvent atteindre la région mentonnière, impliquant l existence d une autre cartographie nerveuse de l innervation sensitive de la face.The mental nerve, entirely sensitive, is a terminal branch of the interior alveolar nerve emerging bilaterally around mandibular second premolar's apex through the mental foramen. Numerous anatomical variations concerning this foramen have been decsribed in the literature, such as unusual locations or occurrence of multiple foramina. However, the absence of mental foramina has only been detected in very occasions, usually during post-mortem dissections. A possible loss of neurosensibility in the area of lower lip and chin is then mentioned. The clinical case reviewed here concerns the fortuitous discovery of mental foramina's bilateral absence on cone beam computed tomography (CBCT) images of a living patient. Vitality and sensibility tests allowed us to objectivize a lack of neurosensorial disturbance in this area. The more likely hypothesis would be an anastomosis with the superficial cervical plexus whose branches have been shown to run through the mental area. This involves the existence of a new sensitive cartography of the face.BORDEAUX1-Bib.electronique (335229901) / SudocSudocFranceF

Rethinking the old antiviral drug moroxydine: discovery of novel analogues as anti-hepatitis C virus (HCV) agents

The discovery of a novel class of HCV inhibitors is described. The new amidinourea compounds were designed as isosteric analogues of the antiviral drug moroxydine. The two derivatives 11g and 11h showed excellent HCV inhibition activity and viability and proved to inhibit a step(s) of the RNA replication. The new compounds have been synthesized in only three synthetic steps from cheap building blocks and in high yields, thus turning to be promising drug candidates in the development of cheaper HCV treatments

A review of Wells, R. & Gianetti, V. (1990). Handbook of Brief Psychotherapies, New York: Plenum

This handbook sets out to provide a comprehensive account of current knowledge on empirically grounded time-limited approaches to psychotherapy. The book contains 25 chapters divided into five sections. The first includes a series of essays on key topics such as theoretical integration, recent innovative approaches to process research, and the implications of mental health policy for brief therapy. The second section covers a number of technical issues such as managing engagement problems, using time limited contracts to promote change, setting tasks and single session therapy. The third, fourth and fifth sections contain review chapters on individual, family and group approaches to brief therapy. Within these chapters, psychodynamic, systems and cognitive-behavioural perspectives are well represented along with a number on interesting integrative approaches

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally