Transvaginal Ultrasonographic Cervical Measurement in Predicting Failed Labor Induction and Cesarean Delivery for Failure to Progress in Nulliparous Women

The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress

Provincial Data-linkage to Address Complex Policy Challenges

Introduction The Province of British Columbia, Canada has established a Data Innovation Program (DI Program) and a Data Science Partnerships Program (DSP Program) to use integrated public-sector data to drive insights into complex policy challenges and support the public good. These programs are a part of the province's new Integrated Data. Objectives and Approach The DI Program was built to enable policy decisions based on a more complete picture of the citizen journey across and throughout government programs. It provides a privacy and security framework for corporate data analytics and a cross-government secure research environment. The DSP Program provides analytics and/or project support for high-priority cross-government projects. The opportunity afforded by this approach to policy decision-making is that valuable data and evidence from multiple sectors can be utilized to make positive changes in the lives of citizens. Results The IDO has partnered with cross government experts on a series of pilot projects that used linked data spanning social services, families and households, education, and health and clinical records. Research topics ranged from the prediction of risk of long-term unemployment, to the impact of the foreign home buyers tax, to the effectiveness of labour market programs. Throughout our presentation we will use these projects as case examples to address the benefits and opportunities provided through our citizen-centred, integrated approach. Conclusion/Implications The future of policy decision-making in terms of service delivery relies on mutually beneficial collaboration and the evidence-based insight available through integrated data. Moving forward, it is essential that researchers across government make the most out of integrated population-level data to solve pressing issues affecting the lives of citizens

Normal cervical changes in parous women during the second half of pregnancy - a prospective, longitudinal ultrasound study

OBJECTIVE: To determine what constitutes normal cervical changes during the second half of pregnancy in parous women delivering at term. DESIGN: The study comprises 21 healthy, pregnant parous women who all gave birth at term. They were examined with transvaginal ultrasound every two weeks from 24 gestational weeks until delivery. Cervical length and width were measured. The inner cervical os was assessed as being closed or open, the length and width of any opening were measured, and dynamic cervical changes (i.e. opening and closing of the inner cervical os during examination) were noted. RESULTS: Median cervical length was 41 mm (range 26-55) at the first examination and 29 mm (range 8-56) at the last examination. The corresponding figures for cervical width were 38 mm (range 29-47) and 46 mm (range 38-64). Cervical length decreased in 18 women but remained unchanged in three. Three patterns of change in cervical length were observed: in 12 women there was a steady, continuous decrease in cervical length (median decrease rate 1.1 mm/week, range 0.6-2.4); in four women the decrease rate accelerated towards the end of pregnancy, the median decrease rate after the change being 3.0 mm/week (range 1.5-4.8); and in two women there was a sudden drop in cervical length at term. Cervical width increased in 16 women but remained unchanged in five. Two patterns of change in cervical width were seen: 14 women manifested a steady continuous increase in cervical width (median 0.8 mm/week, range 0.4-1.8); in two women the increase rate accelerated from around 34 gestational weeks, the increase rate after the change being 4.1 and 5.9 mm/week, respectively. Opening of the internal cervical os was observed at least once in 11 (52%) women and was seen as early as at 24 and 25 gestational weeks in two women. The opening was always V-shaped (median length 6 mm, range 4-17; median width 7 mm, range 3-20). Dynamic changes of the internal cervical os were seen in three women (14%) at 25, 30 and 41 gestational weeks, respectively. CONCLUSION: The cervix of parous women decreases in length and increases in width from midpregnancy to term, but the pattern of change varies between individuals. Knowledge of the different patterns of normal change forms the basis of transvaginal ultrasound studies of pathological cervical changes during pregnancy

CAUSES OF SPATIAL USE BY SEASON IN CHAHAR-FASL HOUSES OF PERSIAN DESERT WITH A CRITICAL OVERVIEW ON THE CONTEMPORARY APPROACH TO VERNACULAR ARCHITECTURE OF DEVELOPING COUNTRIES

This dissertation is submitted to meet the potential and problems of chahar-fasl houses of Persian desert in response to regional extremes. Although, most of the climatological and scientific analysis of this specific region and other regions with similar climatic conditions took place by stu

CAUSES OF SPATIAL USE BY SEASON IN CHAHAR-FASL HOUSES OF PERSIAN DESERT WITH A CRITICAL OVERVIEW ON THE CONTEMPORARY APPROACH TO VERNACULAR ARCHITECTURE OF DEVELOPING COUNTRIES

This dissertation is submitted to meet the potential and problems of chahar-fasl houses of Persian desert in response to regional extremes. Although, most of the climatological and scientific analysis of this specific region and other regions with similar climatic conditions took place by stu

Sustainable road safety improvement through the promotion of an alternative mode : Okanagan Valley electric rail

Across North America there is an increasing demand for safer, faster, less energy intensive and less costly modes of transportation. There are enormous social and economic costs associated with road collisions, which have been recognized world-wide as a serious problem. One local alternative to reduce auto use and resultant road collisions is the placement of a railway line through the Okanagan Valley in British Columbia, Canada, connecting Osoyoos and US railways in the south with Vernon and cross-Canada railways in the north. This line would not only be able to service Okanagan Valley commuters and tourists, currently served by Highway 97, but also provide an additional freight link between the United States and Canada. The objectives of this research were threefold: (1) To develop a set of macro-level collision prediction models for Highway 97, for use in calculating the Safety benefits of the proposed railway, (2) To conduct a comprehensive literature review of the design issues and costs of railway freight and passenger systems, and, (3) To conduct a social cost-benefit analysis of electric railways in Canada for a case study of the Okanagan Valley. To this end, a conceptual design, including route alignment, traffic forecast as well as a social benefit/cost analysis, was conducted. The paucity of data and studies for the Okanagan Valley regarding railway planning and engineering required several extrapolations from data reported in the literature. These estimates were made to gain insight into the data needed to conduct full scale analyses where gaps in knowledge exist, for the purpose of further research. The results of this research were in line with expectations. Regarding sustainable road safety, the development of macro-level collision prediction models for Highway 97 was successful. Regarding knowledge gaps, several were identified on traffic and cost data, and in freight forecast models. However, what was available allowed an order-of magnitude construction cost estimate of 990 million 2007 dollars for 176 kilometres of track. Moreover, if an electric railway began operating in 2050, the benefit/cost ratio of the project was estimated at 1.15, suggesting an Okanagan Valley railway warrants further research.Applied Science, Faculty ofEngineering, School of (Okanagan)Graduat