Thompson CM, Puterman AS, Linley LL, Hann M, van der Elst CW, Molteno CD, Malan AF. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period was tested. The value of the score in predicting neurodevelopmental outcome at 1 y of age was assessed. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. In addition to the hypoxic ischaemic encephalopathy score all but two infants had at least one cranial ultrasound examination. Thirty-five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, four who died before 6 months of age and one infant who was hospitalized at the time of the 12 month assessment. Twenty-three (58%) of the infants were normal and 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. The hypoxic ischaemic encephalopathy score was highly predictive for outcome. The best correlation with outcome was the peak score; a peak score of 15 or higher had a positive predictive value of 92% and a negative predictive value of 82% for abnormal outcome, with a sensitivity and specificity of 71% and 96%, respectively. For the clinician working in areas where sophisticated technology is unavailable this scoring system will be useful for assessment of infants with hypoxic ischaemic encephalopathy and for prognosis of neurodevelopmental outcome. 0 Cerebral palsy, hypoxic ischaemic encephalopathy, neurodevelopment, term infants C Thompson, Neonatal Medicine, Groote Schuur Hospital, Observatory, 7925, Cape Town, RSA

SUMMARYA robust, artiÿcial compressibility scheme has been developed for modelling laminar steady state and transient, incompressible ows over a wide range of Reynolds and Rayleigh numbers. Artiÿcial compressibility is applied in a consistant manner resulting in a system of preconditioned governing equations. A locally generalized preconditioner is introduced, designed to be robust and o er good convergence rates. Free artiÿcial compressibility parameters in the equations are automated to allow ease of use while facilitating improved or comparable convergence rates as compared with the standard artiÿcial compressibility scheme. Memory e ciency is achieved through a multistage, pseudo-timeexplicit time-marching solution procedure. A node-centred dual-cell edge-based ÿnite volume discretization technique, suitable for unstructured grids, is used due to its computational e ciency and high-resolution spatial accuracy. In the interest of computational e ciency and ease of implementation, stabilization is achieved via a scalar-valued artiÿcial dissipation scheme. Temporal accuracy is facilitated by employing a second-order accurate, dual-time-stepping method. In this part of the paper the theory and implementation details are discussed. In Part II, the scheme will be applied to a number of example problems to solve ows over a wide range of Reynolds and Rayleigh numbers.

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The progress-monitoring model enables the quantification of individual hospitals' progress in the process of implementing KMC and an objective measurement of the effectiveness of different outreach strategies. The model also has potential to be adapted for measuring progress in other innovative healthcare interventions on a large scale.

SUMMARYIn Part I of this paper, a preconditioned artiÿcial compressibility scheme was developed for modelling laminar steady-state and transient, incompressible ows for a wide range of Reynolds and Rayleigh numbers. In this part, several examples of laminar incompressible problems are solved and discussed. The in uence of various AC parameters on robustness and convergence rates are assessed for a complex category of problems. It is shown that the scheme developed in Part I is an accurate, robust and easy to use method for solving incompressible laminar ow problems over a wide range of ow regimes.

Aim: To describe the development and testing of a monitoring model with quantitative indicators or progress markers that could measure the progress of individual hospitals in the implementation of kangaroo mother care (KMC). Methods: Three qualitative data sets in the larger research programme on the implementation of KMC of the MRC Research Unit for Maternal and Infant Health Care Strategies in South Africa were used to develop a progress‐monitoring model and an accompanying instrument. Results: The model was conceptualized around three phases (pre‐implementation, implementation and institutionalization) and six constructs depicting progress (awareness, adopting the concept, mobilization of resources, evidence of practice, evidence of routine and integration, sustainable practice). For each construct, indicators were developed for which data could be collected by means of the monitoring instrument used in a walk‐through visit to a hospital. The instrument has been tested in 65 hospitals. Conclusion: The progress‐monitoring model enables the quantification of individual hospitals' progress in the process of implementing KMC and an objective measurement of the effectiveness of different outreach strategies. The model also has potential to be adapted for measuring progress in other innovative healthcare interventions on a large scale.

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