A one-stop perineal clinic: our eleven-year experience.

INTRODUCTION AND HYPOTHESIS: The perineal clinic is a dedicated setting offering assessment for various childbirth-related presentations including obstetric anal sphincter injuries (OASIs), perineal wound complications, pelvic floor dysfunction and other conditions such as female genital mutilation(FGM). We describe the clinical presentation and outcomes of women from a tertiary perineal clinic based on data collected over an 11-year period. METHODS: This is a retrospective observational study. A one-stop outpatient service was offered to all women who sustained OASIs (postnatally and antenatally in a subsequent pregnancy), perineal complications (within 16 weeks postpartum), FGM and/or peripartum symptoms of urinary/anal incontinence or prolapse. Assessment included history with validated questionnaires, examination and anal manometry and endoanal ultrasound when appropriate. Outcomes were compared among different grades of OASIs. Management of each type of presentation was reported with outcomes. RESULTS: There were 3254 first attendance episodes between 2006 and 2016. The majority (58.1%) were for OASIs, followed by perineal wound complications. Compared to the lower grades, the higher grades of OASI were associated with poorer outcomes in terms of symptoms, investigations and complications. Women with OASIs had unrelated symptoms such as urinary incontinence, perineal pain and wound infections that needed further intervention. A high proportion(42%) of wound complications required further specialist management. CONCLUSION: We describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities

Wildfire monitoring via the integration of remote sensing with innovative information technologies

In the Institute for Space Applications and Remote Sensing of the National Observatory of Athens (ISARS/NOA) volumes of Earth Observation images of different spectral and spatial resolutions are being processed on a systematic basis to derive thematic products that cover a wide spectrum of applications during and after wildfire crisis, from fire detection and fire-front propagation monitoring, to damage assessment in the inflicted areas. The processed satellite imagery is combined with auxiliary geo-information layers, including land use/land cover, administrative boundaries, road and rail network, points of interest, and meteorological data to generate and validate added-value fire-related products. The service portfolio has become available to institutional End Users with a mandate to act on natural disasters and that have activated Emergency Support Services at a European level in the framework of the operational GMES projects SAFER and LinkER. Towards the goal of delivering integrated services for fire monitoring and management, ISARS/NOA employs observational capacities which include the operation of MSG/SEVIRI and NOAA/AVHRR receiving stations, NOA's in-situ monitoring networks for capturing meteorological parameters to generate weather forecasts, and datasets originating from the European Space Agency and third party satellite operators. The qualified operational activity of ISARS/NOA in the domain of wildfires management is highly enhanced by the integration of state-of-the-art Information Technologies that have become available in the framework of the TELEIOS (EC/ICT) project. TELEIOS aims at the development of fully automatic processing chains reliant on a) the effective storing and management of the large amount of EO and GIS data, b) the post-processing refinement of the fire products using semantics, and c) the creation of thematic maps and added-value services. The first objective is achieved with the use of advanced Array Database technologies, such as MonetDB, to enable efficiency in accessing large archives of image data and metadata in a fully transparent way, without worrying for their format, size, and location, as well as efficiency in processing such data using state-of-the-art implementations of image processing algorithms expressed in a high-level Scientific Query Language (SciQL). The product refinement is realized through the application of update operations that incorporate human evidence and human logic, with semantic content extracted from thematic information coming from auxiliary geo-information layers and sources, for reducing considerably the number of false alarms in fire detection, and improving the credibility of the burnt area assessment. The third objective is approached via the combination of the derived fire-products with Linked Geospatial Data, structured accordingly and freely available in the web, using Semantic Web technologies. These technologies are built on top of a robust and modular computational environment, to facilitate several wildfire applications to run efficiently, such as real-time fire detection, fire-front propagation monitoring, rapid burnt area mapping, after crisis detailed burnt scar mapping, and time series analysis of burnt areas. The approach adopted allows ISARS/NOA to routinely serve requests from the end-user community, irrespective of the area of interest and its extent, the observation time period, or the data volume involved, granting the opportunity to combine innovative IT solutions with remote sensing techniques and

Operational Wildfire Monitoring and Disaster Management Support Using State-of-the-art EO and Information Technologies

Fires have been one of the main driving forces in the evolution of plants and ecosystems, determining the current structure and composition of the Landscapes. However, significant alterations in the fire regime have occurred in the recent decades, primarily as a result of socioeconomic changes, increasing dramatically the catastrophic impacts of wildfires as it is reflected in the increase during the 20th century of both, number of fires and the annual area burnt. Therefore, the establishment of a permanent robust fire monitoring system is of paramount importance to implement an effective environmental management policy. Such an integrated system has been developed in the Institute for Space Applications and Remote Sensing of the National Observatory of Athens (ISARS/NOA). Volumes of Earth Observation images of different spectral and spatial resolutions are being processed on a systematic basis to derive thematic products that cover a wide spectrum of applications during and after wildfire crisis, from fire detection and fire-front propagation monitoring, to damage assessment in the inflicted areas. The processed satellite imagery is combined with auxiliary geo-information layers and meteorological data to generate and validate added-value fire-related products. The service portfolio has become available to institutional End Users with a mandate to act on natural disasters in the framework of the operational GMES projects SAFER and LinkER addressing fire emergency response and emergency support needs for the entire European Union. Towards the goal of delivering integrated services for fire monitoring and management, ISARS/NOA employs observational capacities which include the operation of MSG/SEVIRI and NOAA/AVHRR receiving stations, NOA’s in-situ monitoring networks for capturing meteorological parameters to generate weather forecasts, and datasets originating from the European Space Agency and third party satellite operators. The qualified operational activity of ISARS/NOA in the domain of wildfires management is highly enhanced by the integra

Multicriteria analysis with linguistic variables to support energy policy decisions: A review of methodologies and analysis applications

115 σ.Οι υφιστάμενες ενεργειακές προκλήσεις και οι κλιματικές αλλαγές προβάλλουν την αναγκαιότητα για την αύξηση της παραγωγής της ηλεκτρικής ενέργειας που προέρχεται από τις ανανεώσιμες πηγές ενέργειας. Για τη αύξηση της παραγωγής της ηλεκτρικής ενέργειας από ΑΠΕ, απαιτείται η σύμπραξη όλων των φορέων: πολιτείας, πολιτών και επιχειρήσεων. Επομένως για την αποτελεσματική υποστήριξη αποφάσεων και για την προώθηση των Ανανεώσιμων Πηγών Ενέργειας (ΑΠΕ) και της εξοικονόμηση ενέργειας στο σύγχρονο περιβάλλον λειτουργίας του ενεργειακού τομέα πρέπει να αντιμετωπιστούν σφαιρικά όλα τα θέματα καθώς και οι αλληλεπιδράσεις των τριών εμπλεκομένων κέντρων αποφάσεων, δηλαδή της Πολιτείας, των ενεργειακών εταιρειών και των χρηστών. Επομένως στα πλαίσια της παρούσας διπλωματικής εστιάστηκε στην υποστήριξη αποφάσεων για τη δημιουργία του κατάλληλου πλαισίου κατευθύνσεων για την Πολιτεία, που θα διαμορφώνει ένα ευνοϊκό περιβάλλον για την προώθηση των ΑΠΕ. Οι κλιματικές αλλαγές και η συνεχής άνοδος του ενεργειακού τομέα μαζί με την απαραίτητη προϋπόθεση για βιωσιμότητα έχουν διευρύνει τα πεδία εφαρμογής της ενεργειακής πολιτικής δημιουργώντας νέες προκλήσεις. Υποστηρικτικές μέθοδοι και εργαλεία στον τομέα αποφάσεων, όπως μοντέλα πολυκριτήριας υποστήριξης αποφάσεων (ΠΥA) είναι απαραίτητα για την ενεργειακή πολιτική, κατά την άσκηση των κατάλληλων προσεγγίσεων που είναι απαραίτητες για τη στήριξη της αναδιάρθρωσης του ενεργειακού τομέα σχετικά με τα πρότυπα της εξόρυξης ενέργειας, την παραγωγή, το μετασχηματισμό και τη χρήση, από μη βιώσιμες σε βιώσιμες μορφές ανάπτυξης. Αρχικά, επιχειρείται η παρουσίαση του προβλήματος της αξιολόγησης υποστηρικτικών εργαλείων αποφάσεων με τη χρήση γλωσσικών μεταβλητών για την προώθηση ΑΠΕ μέσω περιγραφής της παρούσας κατάστασης και της σύνδεσης της προώθησης των ΑΠΕ με το ευρύτερο πλαίσιο της ενεργειακής πολιτικής. Ακολούθως, παρουσιάζεται και αξιολογείται το θεωρητικό πλαίσιο των μεθόδων επεξεργασίας των γλωσσικών όρων. Επίσης, παρουσιάζεται το μαθηματικό υπόβαθρο διαφόρων πολυκριτήριων μεθοδολογιών με χρήση γλωσσικών μεταβλητών. Στη συνέχεια, διερευνήθηκε η χρήση των γλωσσικών μεταβλητών στην επιχειρησιακή έρευνα στα πλαίσια της επαρκούς αντιμετώπισης του τριγώνου της ενεργειακής πολιτικής το οποίο αποτελείται από την ασφάλεια του εφοδιασμού, την ανταγωνιστικότητα του ενεργειακού τομέα της και την προστασία του περιβάλλοντος. Τέλος, διατυπώνεται μεθοδολογική προσέγγιση η οποία ερευνά και αξιολογεί τα διαθέσιμα προγράμματα προώθησης των ΑΠΕ καθώς και τις διαθέσιμες τεχνολογίες τους.The current energy challenges and climate changes highlight the need to increase the production of electricity from renewable energy sources. To increase the production of electricity from RES requires the involvement of all actors: state, citizens and businesses. Therefore for effective decision support for the promotion of Renewable Energy Sources (RES) and energy efficiency in the modern operating environment in the energy sector all issues must be addressed comprehensively and the interactions of the three decision-makers involved, ie the state of energy companies and users. Therefore the present study is focused on decision support for the creation of an appropriate framework of guidelines for the state, which creates a favorable environment for the promotion of RES. Climate change and the continued growth of the energy sector with the necessary condition for sustainability have broadened the scope of energy policy, creating new challenges. Supporting methods and tools in decisions such as multicriteria decision support models (MCDA) is necessary for energy policy in the exercise of appropriate approaches necessary to support the restructuring of the energy sector on standards of energy extraction, production , transformation and use, from unsustainable to sustainable forms of development. Initially, it is attempted to present the problem of evaluation decision support tools using linguistic variables for the promotion of RES through description of the current situation and connecting the promotion of RES to the broader context of energy policy. Afterwards, it is presented and is evaluated the theoretical framework for the processing of linguistic terms. It also presents the mathematical background of various multicriteria methodologies using linguistic variables. Then, it is investigated the use of linguistic variables in operational research as part of an adequate response to the energy policy triangle consisting of security of supply, competitiveness of the energy sector and environmental protection. After that, a methodological approach is expressed which investigates and evaluates the available programs to promote renewable energy and available technologies.Σταύρος Δ. Σιούτη

Epidemiology of female urinary incontinence in the Greek population: EURIG study

Introduction and hypothesis: We estimated the current prevalence of urinary incontinence (UI) in the female Greek population, estimated the prevalence of the subtypes of UI, and assessed its impact on patients' quality of life. Methods: The study was performed by personal interview based on structured questionnaires, and 2,000 Greek women (from the whole of Greece) aged between 20 and 80 years old participated in the study. Results: The prevalence of UI in a female Greek population comprising women aged between 20 and 80 years was 27%. The impact was proportional to the frequency and severity of the UI. UI had no effect or only a mild effect on patients' quality of life. Conclusion: Significant improvement is required in patient information about the nature of UI and its effects on life, and about available treatments (conservative and surgical), and their efficacy and complications. © 2009 The International Urogynecological Association

The OPPIuM technique: office hysteroscopic technique for the preparation of partially intramural leiomyomas.

Uterine fbroids, also known as leiomyomas, represent the most common benign tumors of the female genital tract. Submucosal leiomyomas are classifed into three grades: G0, GI, GII according to the degree of their intramural proportion. A recently developed technique enables the preparation of G1 and G2 leiomyomas for their subsequent successful resection in a second step. The OPPIuM (offce preparation of partially intramural leiomyomas) technique aims to downgrade type i and ii leiomyomas, in order to facilitate a subsequent easier and safer resectoscopy. Hysteroscopic resection of large GI or GII submucosal fbroids is a complex procedure. OPPIuM technique has been invented and seems to achieve the downgrading of these types of leiomyomas in approximately 93% of cases, without any signifcant surgical complications or the need of hormonal agents’ administration. in this way, the safer and quicker subsequent complete myomectomy is facilitated

The amount and duration of smoking is associated with aggravation of hormone and biochemical profile in women with PCOS

We investigated the association between the amount and duration of smoking on biochemical, clinical parameters and the ovarian morphology in women with polycystic ovary syndrome (PCOS). That was a retrospective study. These women were divided into two groups, non-smokers (217) and smokers (92). The amount of cigarettes and duration of smoking was measured in pack-years. Both groups underwent clinical evaluation, biochemical and hormone analysis, transvaginal ultrasound and oral glucose tolerance tests (OGTT). The mean value of the number of cigarettes was 14.8 (±8.8) and the median value of pack-years in the smokers group was 4.0 (1.5-7.5). Smokers group has significantly higher free testosterone (F-T), 17-hydroxyprogesterone (17-OHP), delta 4 androstenedione (Δ4-A), T4, low-density lipoprotein (LDL), and white blood cells (WBC). During correlation of all the above parameters and pack-years, there has been significant positive correlation in F-T and Δ4-A. The participants with more pack-years showed statistically higher values of F-T and Δ4-A. There was also a significant positive correlation between total cholesterol, triglycerides, WBC and pack-years of the participants. Prolactin (PRL) has been inversely associated with pack-years. We concluded that the increase of pack-years aggravated lipid profile, WBC and decreased PRL levels, in PCOS patients. © 2015 Taylor & Francis

Low-Grade Appendiceal Mucinous Neoplasm Presenting as an Adnexal Mass.

Appendiceal tumors are rare, late diagnosed neoplasms that may not be differentiated from adnexal masses even by advanced imaging methods and other diagnostic procedures. They may be asymptomatic and remain undiagnosed until surgery. We report a case of an 80-year-old postmenopausal woman presenting with a pelvic mass and a history of weight loss. The patient underwent laparotomy which revealed an appendiceal mucocele, for which she received a full oncological procedure. The histology report showed a low-grade appendiceal mucinous neoplasm, and the patient underwent six cycles of chemotherapy. Appendiceal tumors should be kept in mind in patients with adnexal mass