Eat Healthy, Lose Weight, Exercise, Change Your Lifestyle… And Have FUN While Doing It!

This handout depicts four fun ways to help manage obesity, tips on eating healthy, losing weight, exercising and changing lifestyle. All information is based on evidence-based research on these topics.https://dune.une.edu/an_studedres/1106/thumbnail.jp

Bed Spaces Management System for the Libyan Public Hospital Al-Jumhouriya in Benghazi

Recently, the online services have used widely in different fields for providing and facilitating user needs. Most of these services give the flexibility and easy to access anytime and anywhere without need to waste the time. This study was initialed for the current issues in determining the bed availability in the Libyan public hospital Al-Jumhouriya in Benghazi for pregnant. Thus, this study successful designed and developed the system based on the System Research Process Methodology. The system was developed based on JSP and MySQL tools and tested on local server. The result of the evolution found that the proposed Bed Reservation System (BRS) was easy to use, useful and achieve the uses intention in using it

Herlyn–Werner–Wunderlich Syndrome: Presentation and Surgical Management Options for Five Cases

Background: Herlyn?Werner?Wunderlich syndrome is a rare Müllerian-duct anomaly consisting of uterine didelphys, a unilateral obstructed hemivagina, and ipsilateral renal agenesis. This article presents clinical and laparoscopic findings as well as the surgical management of 5 cases with various clinical scenarios. Cases: Case 1: An 11-year-old premenarchal female presented with chronic vaginal discharge and negative cultures. She had a uterus didelphys, a unilateral partial obstructed hemivagina, and ipsilateral renal agenesis. She underwent excision of the hemivagina. Case 2: A 14-year-old female presented with severe dysmenorrhea. As part of the work-up for a two-vessel cord at birth, an ultrasound revealed an absent left kidney. Magnetic resonance imaging suggested uterine didelphys and a left hematometrocolpos. At surgery, the MRI findings were confirmed. She underwent excision of the left hemivagina. Case 3: A 23-year-old asymptomatic female was referred following an incidental finding of a duplicated uterine horn and hematocolpos on ultrasound. She had a uterus didelphys, a unilateral obstructed hemivagina, and ipsilateral renal agenesis. She underwent excision of the hemivagina. Case 4: A 26-year-old female presented with severe dysmenorrhea and chronic pelvic pain. She had a uterus didelphys and a high right-sided obstructed hemivagina, with no hematocolpos, hematometra, hematosalpinx, endometrioma, and ipsilateral renal agenesis. She underwent a hemihysterectomy, unilateral salpingectomy, and endometrioma excision. Case 5: A 15-year-old female had a history of severe dysmenorrhea. During laparoscopy for an acute abdomen, she was noted to have uterus didelphys. Further evaluation revealed a hypoplastic cervix and a high right-sided obstructed hemivagina, with minimal hematocolpos, hematometra and ipsilateral renal agenesis. She underwent a hemihysterectomy. Results: The patients recovered well and, in most cases, had complete resolution of their symptoms. In Case 4, the patient's symptoms were greatly reduced. Conclusions: In patients with obstructed hemivaginas that are diagnosed early, resection of the vaginal septum is a convenient and effective treatment modality. Hemihysterectomy should be considered in patients with cervical hypoplasia/aplasia and high position of obstructed hemivaginas, and in patients with severe endometriosis, tubal damage, and extensive pelvic adhesions. (J GYNECOL SURG 31:46)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140097/1/gyn.2014.0081.pd

Pregnancy Outcomes After Endometrioma Excision in Patients Undergoing In Vitro Fertilization and Embryo Transfer: A Historical Cohort Study

Objective: The objective of the study was to examine the effect of endometrioma excision on pregnancy outcomes in women with advanced-stage endometriosis who underwent in vitro fertilization and embryo transfer (IVF-ET). Design: This is a historical cohort study. Materials and Methods: We compared the pregnancy outcomes of 141 women undergoing IVF-ET. The study group consisted of 25 patients who had stage III/IV endometriosis and endometrioma excision (group 1). The control groups included 40 patients who had stage III/IV endometriosis, but no endometrioma and who underwent ovariolysis (group 2) and 76 patients with tubal factors infertility who underwent tubal surgery (group 3). After surgery up to two IVF-ET cycles in each group were analyzed. Results: Our study showed that the mean total dose of gonadotropin administered in IVF-ET cycle I was higher in group 1 compared with groups 2 and 3 (p=0.03). Otherwise, there was no significant difference in the ovarian responses among the three groups. There was a statistically significant increase in clinical pregnancy rate per cycle in the endometrioma group (69.7%) versus the ovariolysis group (48.1%) and tubal factor group (48.0%). However, there was no significant difference in delivery rate per cycle among the three groups. There was a statistically significant higher miscarriage rate in the endometrioma group (39.1%) compared with the ovariolysis group (11.5%) and tubal factor group (14.3%). Conclusion: In conclusion, our study suggests that endometrioma excision surgery does not compromise the overall ovarian reserve or pregnancy outcomes after IVF-ET. (J GYNECOL SURG 31:214)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140100/1/gyn.2015.0013.pd

The theme of alienation in the major novels of Thomas Hardy

The predicament of human isolation and alienation is a pervasive theme that has not been sufficiently studied in Thomas Hardy's fiction. This study investigates the theme of alienation focussing on Hardy's major novels. Although the term 'alienation' is one of the most outstanding features of this age, it is not very clear what it precisely means. The writer has to draw extensively on Hegel, Marx, Fromm and other thinkers to understand the complex ramifications of the term. The numerous connections in which the term has been used are restricted to include only a few meanings and applications among which the most important refers to a disparity between one's society and one's spiritual interests or welfare. The theme of alienation, then, is investigated in representative texts from the wide trajectory of Victorian literature. It is clear that the central intellectual characteristic of the Victorian age is, as Arnold diagnosed it, "the sense of want of correspondence between the forms of modern Europe and its spirit". The increasing difficulty of reconciling historical and spiritual perspectives has become a major theme for Hardy and other late Victorians. Next, each of Hardy's major novels is given a chapter in which the theme of alienation is traced. In Far from the Madding Crowd, Boldwood's neurotic and self-destructive nature makes him obsessed with Bathsheba, and as a result, murders Troy and suffers the isolation of life imprisonment; Fanny Robin's tragic and lonely death, only assisted by a dog, is a flagrant indictment of society. In The Return of the Native, Clym is the earliest prototype in Hardy's fiction of alienated modern man. He returns to Egdon Heath only to live in isolation unable to communicate with the very people whom he thought of as a cure for his alienation. Eustacia has consistently been leading a life of alienation in Egdon Heath which leads to her suicide. In The Mayor of Casterbridge, Henchard's alienation may be more ascribed to his own character, recalling Boldwood, than to incongruity with society. Yet Hardy emphasises the tendency of society towards modernity which Henchard cannot cope with. In The Woodlanders, not only does wild nature fail to be a regenerative and productive force bet also human nature fails to be communicative and assuring. The people of Little Hintock fail to communicate with iry other. The relationship between Marty and Giles is an "obstructed relationship"; Giles dies a sacrificial death, and Marty ends as a wreck in a rare scene hardly credible in a newly emerging world. Fitzpiers and Mrs Charmond, on the other hand, are isolated in the sterile enclosure of their own fantasies. Grace, anticipating Tess and Sue, is torn in a conflict between two worlds, neither of which can happily accommodate her. In Tess of the D'Urbervilles, Tess, after her childhood experiences at Marlott and later at Trantridge, soon discovers how oppressive society is,particularly when she is rejected by Angel, whom she loves and through whom she aspires to fulfil herself. Angel suffers from self-division in his character, and the conflict between received attitudes and advanced ideas leaves him an embodiment of an alienated man hardly able to reconcile the values of two worlds. Jude the Obscure is Hardy's most complete expression of alienation. Jude's alienation is explicitly social and implicitly cosmic, and his failure to identify himself in society constitutes a major theme of the novel. The novel foreshadows the modern themes of failure, frustration, futility, disharmony, isolation, rootlessness, and absurdity as inescapable conditions of life. In conclusion, the theme of alienation in the major novels of Thomas Hardy is a pervasive one. Nevertheless, not all his characters are alienated; however their happy condition, like that of the rustics in Gray's Elegy, is seen to stem from their intellectual limitations

Successful Surgical and Medical Management of Cesarean Scar Pregnancy in 2 Patients

Background: Cesarean scar pregnancy (CSP), once a rare entity, is on the rise due because of an increase in the cesarean section rate worldwide. Currently, there is no standard protocol available for managing CSP. To contribute to the existing literature, this article presents the current authors' experience with 2 cases of CSP that were treated successfully with two different modalities. Cases: Case 1: A 34-year-old, gravida 2, para 1, was diagnosed with a CSP on initial transvaginal ultrasound (TVUS) scan at 6 weeks of gestation. Aspiration of the gestational sac and a local injection of methotrexate was performed. After 2 weeks, the gestational sac increased in size with thinning of the CS scar (1?mm), and plateauing of the ß?human chorionic gonadotropin (ß-hCG) occurred. Laparoscopic excision of the CSP and myometrial repair resulted in resolution. Case 2: A 31-year-old, gravida 3, para 1, achieved pregnancy after a frozen?thawed embryo transfer cycle. A TVUS scan, performed at 6 weeks of gestation showed a CSP. The patient's ß-hCG level was 310 mIU/mL. Systemic methotrexate was administered intramuscularly. The patient's ß-hCG on days 4 and 7 was 260 and 252, respectively. A repeat TVUS on day 7 showed a resolving gestational sac. A second dose of methotrexate resulted in complete resolution of the CSP. Results: The treatments (aspiration, methotrexate, and laparoscopic excision for Case 1, and methotrexate for Case 2) enabled resolution of the CSPs of these 2 patients. Conclusions: Various treatment modalities have been described for managing CSP with varied levels of success. When local injection of methotrexate into the gestational sac of CSP is unsuccessful, laparoscopic removal is safe and effective. Moreover, in the presence of low levels of ?-hCG, treatment with systemic methotrexate is usually successful. (J GYNECOL SURG 30:168)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140096/1/gyn.2013.0131.pd

Management Dilemma of Concurrent Fundal Submucous Fibroid and Incomplete Uterine Septum in a Patient with Recurrent Pregnancy Loss

Background: We describe a patient presenting with recurrent pregnancy loss secondary to concurrent uterine factors. Case: The patient was a 31-year-old white female who presented with recurrent pregnancy loss on two occasions. The couple had a normal work-up for recurrent miscarriages except for a fundal type II submucosal fibroid on transvaginal 3D ultrasound (US) with saline infusion hysterosonogram (SIH). Laparoscopic myomectomy and repair of the myometrial defect was performed. At the conclusion of the procedure, a diagnostic hysteroscopy suggested a possible concurrent incomplete short uterine septum, which could not be corrected for fear of cutting the myomectomy sutures. The patient did not appear for follow up, which led her to have three more miscarriages and one chemical pregnancy. The presence of a short uterine septum was confirmed on SIH with 3D US. The patient underwent hysteroscopic division of the short uterine septum. Results: Postoperative SIH showed a normal uterine cavity, and currently the patient is trying to conceive. Conclusion: Coexistence of a type II submucous fibroid in the fundal region of the uterus and an incomplete uterine septum presents both a diagnostic and management challenge. Surgical management of such coexisting uterine pathology cannot be performed in a single session. (J GYNECOL SURG 29:165)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140093/1/gyn.2012.0029.pd

Successful Management of Infertile Patient with Trans-Fundal Uterine Membrane

Background: This case report describes an infertile patient with a rare endometrial cavity pathology diagnosed on hysteroscopy. Case: The patient was a 39-year-old female with primary infertility of 9 years' duration. A diagnosis of a possible T-shaped uterus on a previous hysterosalpingogram was not confirmed on diagnostic hysteroscopy 5 years earlier at a different infertility center, where she had undergone a cycle of in-vitro fertilization with embryo transfer (IVF-ET) but was unable to conceive. At the time of diagnostic hysteroscopy at the current, unit the patient was found to have a T-shaped cavity and a trans-fundal uterine membrane obscuring an arcuate fundus. Hysteroscopic division of this thin membrane was performed successfully, followed by hysteroscopic division of the uterine septum and hysteroscopic metroplasty of her T-shaped uterus. Results: Subsequently, the patient conceived with IVF-ET but had an early miscarriage. A second IVF-ET cycle resulted in resulted in delivery of a healthy male infant at term. Conclusions: This report described a case of an infertile patient with a trans-fundal membrane in association with a uterine anomaly. The discovery of such a membrane and the uterine anomaly described above, and their hysteroscopic surgical correction, may have contributed to the successful reproductive outcome for this patient. (J GYNECOL SURG 29:88)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140092/1/gyn.2012.0028.pd

Rethinking public space in the city of Jeddah, Saudi Arabia

Thesis (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 2012.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (p. 139).Can urban intervention affect social behaviors within a city? And if so, what happens when that city is partial to cultural restrictions? The target in question here is the city of Jeddah, Saudi Arabia. The dilemma is that the city has no true form of public space; despite having spaces designated as such. The lack of public space can be related to two main aspects linked to the nature of the city: 01. Gender Segregation: Questioning what actually IS public if both males and females can't access these spaces freely. 02. The development of the city since the oil boom: Looking at social, economic, demographic and urban ramifications. My thesis serves as a contribution to the social needs of the Saudi society in Jeddah today. By questioning the issue of 'publicness' I intend to analyze how the development of the city has been affected by the cultural restrictions imposed upon it.by Reem Abuzeid.M.Arch

Reconstruction of Long Anterior Urethral Strictures by Dorsally Quilted Penile Skin Flap

Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long