On substructuring algorithms and solution techniques for the numerical approximation of partial differential equations

Substructuring methods are in common use in mechanics problems where typically the associated linear systems of algebraic equations are positive definite. Here these methods are extended to problems which lead to nonpositive definite, nonsymmetric matrices. The extension is based on an algorithm which carries out the block Gauss elimination procedure without the need for interchanges even when a pivot matrix is singular. Examples are provided wherein the method is used in connection with finite element solutions of the stationary Stokes equations and the Helmholtz equation, and dual methods for second-order elliptic equations

New discretization and solution techniques for incompressible viscous flow problems

Several topics arising in the finite element solution of the incompressible Navier-Stokes equations are considered. Specifically, the question of choosing finite element velocity/pressure spaces is addressed, particularly from the viewpoint of achieving stable discretizations leading to convergent pressure approximations. The role of artificial viscosity in viscous flow calculations is studied, emphasizing work by several researchers for the anisotropic case. The last section treats the problem of solving the nonlinear systems of equations which arise from the discretization. Time marching methods and classical iterative techniques, as well as some modifications are mentioned

Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor

Objective: To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 hours of induction of labor. Methods: This was a prospective observational study in 1,902 singleton pregnancies undergoing induction of labor at ≥ 37 weeks’ gestation. Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) before induction of labor. The measured UA PI and MCA PI and their ratio were converted to multiples of the median (MoM) after adjustment for gestational age. Univariate and multivariate logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome that was provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for cesarean section for presumed fetal distress and neonatal adverse outcome, which included umbilical arterial or venous cord blood pH ≤7 and ≤7.1, respectively, 5-minute Apgar score 24 hours, or hypoxic ischemic encephalopathy. Results: A combination of maternal and pregnancy characteristics, including age, weight, racial origin, previous obstetric history, preeclampsia, gestational age at delivery and amniotic fluid volume, identified 39% of pregnancies requiring cesarean section for fetal distress at FPR of 10%; addition of CPR did not improve the performance of screening. In screening for adverse neonatal outcome by a combination of parity and CPR the DR was 17% at FPR of 10%. Conclusion: Low CPR, measured within 24 hours of induction of labor, is associated with increased risk of cesarean section for fetal distress and adverse neonatal outcome, but the performance of CPR for such surrogates of adverse perinatal outcome is poor

Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks

Objectives: To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UT-PI) at 19-24 weeks’ gestation and compare this performance to that of screening by UT-PI alone. Methods: This was a prospective screening study of 70,003 singleton pregnancies including 69,735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UT-PI. Results: Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were due to other causes or unexplained, at false positive rate of 10%; within the impaired placentation group the detection rate of stillbirth at 37 weeks (88% vs 46%; p<0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UT-PI being above the 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired placentation and 15% of those that were due to other causes or unexplained. Conclusions: Second-trimester screening by a combination of UT-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and in particular those due to impaired placentation

Two-stage approach for prediction of small-for-gestational-age neonate and adverse perinatal outcome by routine ultrasound examination at 35-37 weeks' gestation

Background: Justification of prenatal screening for small for gestational age (SGA) fetuses near term is based on first, evidence that such fetuses / neonates are at increased risk of stillbirth and adverse perinatal outcome, and second, the expectation that these risks can be reduced by medical interventions, such as early delivery. However, there are no randomized studies demonstrating that routine screening for SGA fetuses and appropriate interventions in the high risk group can reduce adverse perinatal outcome. Before such meaningful studies can be undertaken it is essential that first, the best approach for effective identification of SGA neonates is determined, and second, the contribution of SGA neonates to the overall rate of adverse perinatal outcome is established. In a previous study of pregnancies that had undergone routine ultrasound examination at 35+0 36+6 weeks’ gestation, we found that first, screening by estimated fetal weight (EFW) 85% of SGA neonates requires use of EFW <40th percentile. Objectives: First, to examine the contribution of SGA fetuses to the overall rate of adverse perinatal outcome and second, to propose a two stage approach for prediction of SGA neonates at routine ultrasound examination at 35+0 36+6 weeks’ gestation. Methods: This was a prospective study of 45,847 singleton pregnancies that had undergone routine ultrasound examination at 35+0 36+6 weeks’ gestation. First we examined the relationship between birthweight percentile and adverse perinatal outcome, defined as stillbirth, neonatal death or admission to the neonatal unit for ≥48 hours. Second, we used a two stage approach for prediction of SGA neonates and adverse perinatal outcome; in the first stage fetal biometry was used to distinguish pregnancies at very low risk (EFW ≥40th percentile) and those at increased risk (EFW 4 weeks after assessment was determined. We propose that the high risk group would require monitoring from initial assessment to delivery, the intermediate risk group would require monitoring from two weeks after initial assessment to delivery, the low risk group would require monitoring from four weeks after initial assessment to delivery, and the very low risk group would not require any further reassessment. Results: First, although in babies with low birthweight (4 (40% and 30%) from assessment. Third, improved performance of screening, especially for those delivering after two weeks from assessment, is potentially achieved by a proposed new approach for stratifying pregnancies into management groups based on findings of EFW and Doppler indices (prediction of birthweight 4 weeks from assessment: 89% and 75%, 83% and 74% and 88% and 82%, respectively). Fourth, the predictive performance for adverse perinatal outcome of EFW 4 weeks from assessment, respectively) and this is improved by the proposed new approach (31%, 22% and 29%). Conclusion: The study presents an approach for stratifying the pregnancies undergoing routine ultrasound examination at 35+0 36+6 weeks’ gestation into four management groups based on findings of EFW and Doppler indices. This approach can potentially have a higher predictive performance for SGA neonates and adverse perinatal outcome than screening by EFW <10th percentile

Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome

Objective: To investigate the potential value of uterine artery Doppler at 30 34 weeks’ gestation in the prediction of adverse perinatal outcome. Methods: Screening study in 30,780 singleton pregnancies at 30 34 weeks. Uterine artery pulsatility index (PI) was measured and the values were converted to multiples of the median (MoM) after adjustment from variables in maternal characteristics and medical history that affect the measurements. Multivariable logistic regression analysis was used to determine if uterine artery PI had a significant additional contribution to maternal characteristics, medical history and obstetric factors in predicting adverse outcome. The detection rate (DR) and false positive rate (FPR) of screening by uterine artery PI were estimated for stillbirth, cesarean section for fetal distress, umbilical arter ial cord blood pH <7.0 or umbilical venous pH <7.1 and Apgar score <7 at 5 minutes. Results: The incidence of adverse perinatal outcome was higher in small for gestational age (SGA) than in non SGA fetuses, but the majority of cases for each adverse outcome were in the non SGA group, including about 70% of stillbirths and more than 80% of cases of cesarean section for fetal distress, low cord blood pH and low Apgar score. The performance of uterine artery PI >95 th percentile in screening for each adverse outcome was poor with DR of 6 16% and FPR of 5 6%. T he DR of high uterine artery PI for adverse outcome was higher in the SGA than non SGA groups, including 24% vs. 13% for stillbirth , 15% vs. 5% for cesarean section for fetal distress, 22% vs. 9% for low cord blood pH and 20% vs. 3% for low Apgar score. Conclusion: High uterine artery PI at 30 34 weeks’ gestation may be useful in the prediction of adverse perinatal outcome in pregnancies with SGA fetuses, but not in those with non SGA fetuses

The cold frontal depression that affected the area of Cyprus between 28 and 29 January 2008

The baroclinic depression that affected the area of Cyprus during the cold period, between 28 and 29 January 2008 was thoroughly studied and is presented in the present paper. A small perturbation on a northwesterly flow to the north of Cyprus has initiated the generation of the depression and in 24 h this developed into a deep baroclinic system. This depression was associated with intense weather phenomena, such as heavy thunderstorms with hail and near gale force winds. Strong cold advection resulted in a significant temperature decrease; precipitation even in lower altitudes was in the form of snow, while the accumulated rainfall corresponded to the 25% of the monthly normal. January 2008 is considered as a dry month, despite the fact that, on the average, January is considered as the wettest month of the year. In this study, the evolution and development of the depression was investigated from synoptic, dynamic, energetic and thermodynamic perspectives, in order to enhance our knowledge on the life cycle and behaviour of similar depressions over the area with extreme characteristics

Ultrasound IMT measurement on a multi-ethnic and multi-institutional database: Our review and experience using four fully automated and one semi-automated methods

Automated and high performance carotid intima-media thickness (IMT) measurement is gaining increasing importance in clinical practice to assess the cardiovascular risk of patients. In this paper, we compare four fully automated IMT measurement techniques (CALEX, CAMES, CARES and CAUDLES) and one semi-automated technique (FOAM). We present our experience using these algorithms, whose lumen-intima and media-adventitia border estimation use different methods that can be: (a) edge-based; (b) training-based; (c) feature-based; or (d) directional Edge-Flow based. Our database (DB) consisted of 665 images that represented a multi-ethnic group and was acquired using four OEM scanners. The performance evaluation protocol adopted error measures, reproducibility measures, and Figure of Merit (FoM). FOAM showed the best performance, with an IMT bias equal to 0.025 ± 0.225 mm, and a FoM equal to 96.6%. Among the four automated methods, CARES showed the best results with a bias of 0.032 ± 0.279 mm, and a FoM to 95.6%, which was statistically comparable to that of FOAM performance in terms of accuracy and reproducibility. This is the first time that completely automated and user-driven techniques have been compared on a multi-ethnic dataset, acquired using multiple original equipment manufacturer (OEM) machines with different gain settings, representing normal and pathologic case

Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: Results from the ACSRS study

Objectives. This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. Methods. Patients (n = 1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. Results. The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 μmol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). Conclusions. Linearity between ECST percent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy. © 2005 Elsevier Ltd. All rights reserved